Collateral filling efficiency of comorbid chronic total occlusion segment on short-term mortality in ST-elevation myocardial infarction

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• 作者：Toshiharu Fujii ; Masataka Nakano ; Yohei Ohno ; Gaku Nakazawa ; Norihiko Shinozaki ; Takashi Matsukage ; Fuminobu Yoshimachi ; Yuji Ikari ; ¹ ; ^{ikari@is.icc.u-tokai.ac.jp}
• 关键词：PCI ; percutaneous coronary intervention ; STEMI ; ST-elevation myocardial infarction ; MVD ; multi-vessel disease ; CTO ; chronic total occlusion ; SVD ; single-vessel disease ; IRA ; infarct-related artery ; eGFR ; estimated glomerular filtration rate ; IABP ; intra-aortic balloon pump ; ECLS ; extracorporeal life support
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：346-352
• 全文大小：616 K
• 卷排序：230

文摘

Collateral filling of chronic total occlusion (CTO) segments is considered to affect hemodynamic stability in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) with CTO, however its value as a prognostic indicator for mortality is uncertain. The present study examined the relationship between collateral filling of CTO segments and short-term mortality in patients with STEMI with a comorbid CTO lesion.MethodsAmong 829 STEMI patients who underwent primary PCI, 74 patients with CTO were identified. Collateral filling of their CTO segment was assessed by Rentrop grade (0; n = 10, 1; n = 13, 2; n = 31, 3; n = 20) in their initial angiogram and whether the origin of the feeding collateral donor artery was infarct-related artery (IRA) was evaluated using their final angiogram in primary PCI; IRA (n = 26) and non-IRA group (n = 48). The relationship between these classifications and 30-day all-cause mortality was examined retrospectively.ResultsThe 30-day mortalities were 4.5% in single-vessel disease, 18.3% in multi-vessel disease (MVD) without CTO and 25.7% in MVD with CTO. Mortality of MVD with CTO reduced with increasing Rentrop grade from 0 to 3 (80.0%, 30.8%, 19.4%, and 5.0%, respectively). IRA was associated with a significant higher mortality than those of non-IRA (50.0% vs. 12.5%, P = 0.0004). Low Rentrop grade 0 or 1 was extracted as an independent predictor of 30-day death (HR 3.28, 95% CI 1.20–9.96, P = 0.0203).ConclusionsPoor collateral filling of the CTO segment assessed by Rentrop grade was an independent angiographic predictor for 30-day death in patients with STEMI combined with CTO.