Clinical features and prognostic analysis on patients with ST-segment elevation myocardial infarction with chronic total occlusion

doi:10.3969/j.issn.1006-7795.2015.06.024

Abstract

Abstract: Objective To investigate the clinical features and prognostic analysis on patients with ST-segment elevation myocardial infarction(STEMI) with chronic total occlusion(CTO) in a non-infarct-related artery. Methods In this study, a total of 391 patients with STEMI and receiving primary percutaneous coronary intervention(PCI) were enrolled from January 2011 to November 2012 in Beijing Lube Hospital. According to the existence of CTO, patients were divided into 2 groups;CTO group(41 cases ) and non-CTO group(350 cases). Both groups were given conventional secondary prevention treatment. The clinical feature of STEMI with CTO was analysed. The primary end point was 30-day incidence of MACE and influencing factors on MACE. Results The age, heart failure, renal insufficiency, 3 diseased vessels, shock, malignant arrhythmia, the usage of intra-aortic balloon pupm(IABP) of CTO group were higher than those of non-CTO group(P < 0.05). The rate of thrombolysis in myocardial infarction(TIMI) flow grade 3 after PCI of CTO group was significantly lower than that of non-CTO group(P < 0.05). The peak level of creatine kinase MB(CK-MB) and the left ventricular end-diastolic diameter(LVEDD) in CTO group was significantly higher than that of non-CTO group〔(307.19±149.04)U/L vs (208.08±129.56)U/L;(55.48±5.58)mm vs (52.33±4.41)mm, P < 0.05〕. The ejection fraction(EF) of CTO group was significantly lower than that of non-CTO group(51.86±9.61 vs 57.76±9.20, P < 0.05). The 30-days mortality and MACE of CTO group was significantly higher than that of non-CTO group(22.0 vs 2.9;22.0 vs 3.7, P < 0.05). A stepwise Logistic regression analysis further suggested the following independent predictors to 30-day incidence of major adverse cardiac event(MACE):TIMI flow grade < 3 after PCI, renal insufficiency, anterior wall infarction, age ≥ 65, malignant arrhythmia, CTO. Conclusion The incidence of heart failure, renal insufficiency, shock, malignant arrhythmia and 3 diseased vessels of CTO group was higher than that of non-CTO group. The rate of TIMI flow grade 3 after PCI of CTO group was lower than that of non-CTO group. The 30-days mortality and MACE of CTO group was significantly higher than that of non-CTO group. CTO was the predicting factor of 30-days poor prognosis of STEMI.

Key words: myocardial infarction, acute, percutaneous intervention, chronic total occlusion

CLC Number:

R542.2

Xu Min, Guo Jincheng, Zhang Haibin. Clinical features and prognostic analysis on patients with ST-segment elevation myocardial infarction with chronic total occlusion[J]. Journal of Capital Medical University, 2015, 36(6): 969-973.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2015.06.024

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2015/V36/I6/969

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