Impact on mortality of non-infarct related artery coronary chronic total occlusion in patients presenting with ST-segment elevation myocardial infarction: A systematic review and meta-analysis

Background: To evaluate the impact of the presence of a chronic total occlusion (CTO) on short and long term mortality after primary percutaneous coronary intervention (PPCI). Methods: We performed MEDLINE, Cochrane Controlled Trials Registry and EMBASE database searches for published articles using predefined terms. Studies that reported data on the incidence of all-cause mortality in STEMI patients with single- or multivessel disease (SVD, MVD) with and without CTO were included. Of the 189 studies identified, 5 articles met the inclusion criteria: 3 observational studies and 2 post-hoc analyses of randomized controlled trials (RCTs). Results: A total of 10,314 patients were included in the meta-analysis with overall 1160 (11%) patients with CTO. The global analysis demonstrated that CTO was associated with an over 3-fold increased incidence of mortality at a median follow up of 36 months compared to patients non-CTO patients (30.4% vs 10.1% OR: 3.24; 95% confidence interval [CI]: 2.79 to 3.75; p 0.0001) (Figure). This finding was consistent in a sub-analysis of studies that reported 30-day follow up (17.6% vs 4.2 OR: 4.3; 95% CI: 3.4 to 5.4 p=0.001). Cardiac mortality and MACE were also higher in patients with CTO (14.7% vs 3.7% OR: 4.42; 95% confidence interval [CI]: 3.18 to 6.15; p <0.0001 and 33.5% vs 20.4% OR: 1.97; 95% confidence interval [CI]: 1.56 to 2.47; p <0.0001 respectively). Conclusions: Coronary chronic total occlusion in the non-culprit artery in patients presenting with STEMI is associated with poor long-term mortality. (Table Presented).