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Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study.

Sharma, Vinoda; Choudhury, Anirban; Basavarajaiah, Sandeep; Rashid, Muhammad; Yuan, Mengshi; Jefferey, Daniel; Vanezis, Andrew P; Sall, Hanish; Smith, William H T; Parasa, Ramya; Kelly, Paul; Kinnaird, Tim; Mamas, Mamas A

Authors

Vinoda Sharma

Anirban Choudhury

Sandeep Basavarajaiah

Mengshi Yuan

Daniel Jefferey

Andrew P Vanezis

Hanish Sall

William H T Smith

Ramya Parasa

Paul Kelly

Tim Kinnaird



Abstract

Objectives
To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort.

Background
There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO.

Methods
Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes.

Results
There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42–4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25–2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10–0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %.

Conclusions
In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes.

Citation

Sharma, V., Choudhury, A., Basavarajaiah, S., Rashid, M., Yuan, M., Jefferey, D., …Mamas, M. A. (in press). Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study. Cardiovascular Revascularization Medicine, 64, 62-67. https://doi.org/10.1016/j.carrev.2024.02.008

Journal Article Type Article
Acceptance Date Feb 12, 2024
Online Publication Date Feb 14, 2024
Deposit Date Mar 11, 2024
Journal Cardiovascular revascularization medicine : including molecular interventions
Print ISSN 1553-8389
Electronic ISSN 1878-0938
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 64
Pages 62-67
DOI https://doi.org/10.1016/j.carrev.2024.02.008
Keywords Revascularisation, CTO, NSTEMI
Public URL https://keele-repository.worktribe.com/output/762924
Publisher URL https://www.sciencedirect.com/science/article/pii/S1553838924000496?via%3Dihub