TY - JOUR
T1 - Impact of Chronic Total Occlusions on Markers of Reperfusion, Infarct Size, and Long-Term Mortality: A Substudy from the TAPAS-Trial
AU - Lexis, Chris P. H.
AU - van der Horst, Iwan C. C.
AU - Rahel, Braim M.
AU - Lexis, Monique A. S.
AU - Kampinga, Marthe A.
AU - Gu, Youlan L.
AU - de Smet, Bart J. G. L.
AU - Zijlstra, Felix
PY - 2011/3/1
Y1 - 2011/3/1
N2 - Objectives: This study evaluated the impact of a chronic total occlusion (CTO) in a non-infarct related coronary artery (IRA) on markers of reperfusion, infarct size, and long-term cardiac mortality in patients with ST-elevation myocardial infarction (STEM!). Background: A concurrent CTO in STEMI patients has been associated with impaired left ventricular function and outcome. However, the impact on markers of reperfusion is unknown. Methods: All 1,071 STEMI patients included in the TAPAS-trial between January 2005 and December 2006 were used for this substudy. Endpoints were the association between a CTO in a non-IRA and myocardial blush grade (MBG) of the IRA, ST-segment elevation resolution (STR), enzymatic infarct size, and clinical outcome. Results: A total of 90 patients (8.4%) had a CTO. MBG 0 or 1 occurred more often in the CTO group (34.2% versus 20.6% (Odds Ratio [OR] 2.00, 95% confidence interval [CI]: 1.22-3.23, P = 0.006)). Incomplete STR occurred more often in the CTO group, (63.6% versus 48.2% [OR 1.96, 95% CI: 1.22-3.13, P = 0.005]). Median level of maximal myocardial-band of creatinin kinase (CK-MB) in the CTO group was 75 mu g/l (IQR 28-136) and 51 mu g/l (IQR 18-97) in the no-CTO group (P = 0.021). The presence of a CTO in a non-IRA in STEMI patients was an independent risk factor for cardiac mortality (HR 2.41, 95% CI: 1.26-4.61, P = 0.008) at 25 months follow-up. Conclusion: A CTO in a non-IRA is associated with impaired reperfusion markers and impaired long-term outcome in STEMI patients.
AB - Objectives: This study evaluated the impact of a chronic total occlusion (CTO) in a non-infarct related coronary artery (IRA) on markers of reperfusion, infarct size, and long-term cardiac mortality in patients with ST-elevation myocardial infarction (STEM!). Background: A concurrent CTO in STEMI patients has been associated with impaired left ventricular function and outcome. However, the impact on markers of reperfusion is unknown. Methods: All 1,071 STEMI patients included in the TAPAS-trial between January 2005 and December 2006 were used for this substudy. Endpoints were the association between a CTO in a non-IRA and myocardial blush grade (MBG) of the IRA, ST-segment elevation resolution (STR), enzymatic infarct size, and clinical outcome. Results: A total of 90 patients (8.4%) had a CTO. MBG 0 or 1 occurred more often in the CTO group (34.2% versus 20.6% (Odds Ratio [OR] 2.00, 95% confidence interval [CI]: 1.22-3.23, P = 0.006)). Incomplete STR occurred more often in the CTO group, (63.6% versus 48.2% [OR 1.96, 95% CI: 1.22-3.13, P = 0.005]). Median level of maximal myocardial-band of creatinin kinase (CK-MB) in the CTO group was 75 mu g/l (IQR 28-136) and 51 mu g/l (IQR 18-97) in the no-CTO group (P = 0.021). The presence of a CTO in a non-IRA in STEMI patients was an independent risk factor for cardiac mortality (HR 2.41, 95% CI: 1.26-4.61, P = 0.008) at 25 months follow-up. Conclusion: A CTO in a non-IRA is associated with impaired reperfusion markers and impaired long-term outcome in STEMI patients.
KW - ST-elevation myocardial infarction
KW - myocardial blush grade
KW - ST-segment elevation resolution
KW - pathologic Q waves
KW - reperfusion
U2 - 10.1002/ccd.22664
DO - 10.1002/ccd.22664
M3 - Article
C2 - 20518009
SN - 1522-1946
VL - 77
SP - 484
EP - 491
JO - Catheterization and Cardiovascular interventions
JF - Catheterization and Cardiovascular interventions
IS - 4
ER -