MYOCARDIAL INFARCTION WITH MULTIVESSEL DISEASE. DOES PRESENCE OF CHRONIC TOTAL OCCLUSION MAKES A DIFFERENCE?

Aim:To analyze clinical characteristics, presenting symptoms, and survival of patients with myocardial infarction (MI), multivessel disease (MVD), and the possible impact of chronic total occlusion (CTO) to 1-year mortality.
Methods:All MI patients with MVD (two or three vessel disease) hospitalized in our center from January 2020 to September 2022 (1309 patients) were selected. In cooperation with Institute of Health Information and Statistics we obtained 1-year mortality data. We conducted a propensity score matching (PSM) analysis based on age, gender, and type of MI and compared patients with CTO (CTO group,n=90) and without CTO (Control group,n=90).
Results:There were no difference in presenting clinical symptoms and initial heart rhytm between the groups. Higher trend of 30-day mortality was observed in CTO group compared to the Control group (14.4% vs. 10.0%;n=13 vs. n=9;p=0.36) with a mean survival (MS) of 27.2 days (95% confidence interval [CI]=25.6 to 28.7) in the CTO group and 28.2 days (95% CI=26.9 to 29.5) in the Control group. 1-year follow-up shows all-cause mortality rate of 23.3%(n=21) in the CTO group ([MS]=292.1 days, 95% CI=263.8 to 320.4) and 18.9%(n=17) in the Control group ([MS]=310.2 days, 95% CI=285.3 to 335.2),p=0.44. Landmark analysis emphasize mortality distribution (Graph). PCI alone was performed in 64.4%(n=58) in both groups, CABG in 18.8%(n=17) and 24.4%(CTO vs. Control group respectively). Combination of both (PCI and CABG) occurred in 8.8%(n=8) in both groups and conservative treatment was chosen for 7 CTO and 2 Control group.
Conclusion:We observed higher 30-day mortality trend in patients with MI , MVD and a CTO compared to a matched cohort with MI, MVD without CTO. Mortality after 30-days up to 1-year mortality in both groups is comparable. CABG treated patients had excellent survival, irrespective of CTO presence.