Author + information
- Pedro Villablanca1,
- Wilman Olmedo2,
- Michael Weinreich3,
- Divyanshu Mohananey4,
- Tanush Gupta5,
- Cristina Sanina2,
- Muhammad Farooq6,
- Emily Ong6,
- Thomas Brevik7,
- Diego Castellon8,
- Harish Ramakrishna9,
- Mario Garcia2,
- Robert Pyo6,
- Mark Menegus10,
- Anna Bortnick3 and
- Jose Wiley2
- 1New York University, New York, New York, United States
- 2Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
- 3Montefiore Medical Center, Bronx, New York, United States
- 4Cleveland Clinic, Cleveland, Ohio, United States
- 5Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States
- 6Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
- 7Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, New York, United States
- 8Medical University of the Americas, Devens, Massachusetts, United States
- 9Mayo Clinic, Phoenix, Arizona, United States
- 10montefiore, bronx, New York, United States
Studies have shown that the presence of concurrent chronic total occlusion (CTO) in a non-infarct related artery (nIRA) in ST-elevation myocardial infarction (STEMI) patients is associated with increased mortality. Despite this, it remains unclear if revascularization of a nIRA CTO in STEMI translates to improved outcomes. We performed a meta-analysis to compare outcomes between patients presenting with STEMI with concurrent CTO who underwent percutaneous coronary intervention (PCI) of nIRA CTO vs. those who did not.
We conducted an electronic database search of all published data. The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause mortality, stroke, myocardial infarction (MI), and repeat revascularization (RRV). Secondary endpoints were all-cause mortality, cardiovascular (CV) mortality, MI, RRV either with PCI or Coronary Artery Bypass Grafting (CABG), stroke, and heart failure readmission. Odds ratios (OR) and 95% confidence intervals (CI) were computed using the Mantel-Haenszel method. A fixed-effect model was used; if heterogeneity was (I2)>25, effects were obtained using a random effects model.
Five studies (n=876 patients) were included in the analysis. There was a statistically significant difference in heart failure readmissions favoring those receiving nIRA CTO PCI as compared to those who did not (OR 0.53, 95% CI 0.29-0.95). No statistically significant differences was observed between two groups for MACE (OR 0.79, 95% CI 0.32-1.96), all-cause mortality (OR 0.57, 95% CI 0.23-1.39), CV mortality (OR 0.54, 95% CI 0.21-1.34), MI (OR 0.92, 95% CI 0.46-1.84), RRV (OR 1.27, 95% CI 0.57-2.83), or strokes (OR 0.49, 95% CI 0.19-1.25).
In this meta-analysis, CTO PCI of the nIRA CTO in patients presenting with STEMI was associated with a significant reduction in HF readmissions, but not with MACE, mortality, stroke, MI, or RRV among patients who underwent CTO PCI. Additional studies are needed to fully understand the role of CTO revascularization in STEMI patients.
CORONARY: Acute Coronary Syndromes