Impact of the origin of the collateral feeding donor artery on short-term mortality in ST-elevation myocardial infarction with comorbid chronic total occlusion
| Autor: | Toshiharu Fujii, Takashi Matsukage, Gaku Nakazawa, Fuminobu Yoshimachi, Katsuaki Sakai, Norihiko Shinozaki, Yuji Ikari, Masataka Nakano, Yohei Ohno |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Comorbidity 030204 cardiovascular system & hematology 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Aged Proportional Hazards Models Intra-aortic balloon pump Aged 80 and over business.industry Proportional hazards model Percutaneous coronary intervention Arteries Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Coronary Occlusion Coronary occlusion Conventional PCI cardiovascular system Cardiology ST Elevation Myocardial Infarction Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | International Journal of Cardiology. 218:158-163 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2016.05.023 |
| Popis: | Patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD) have higher mortality, especially with comorbid chronic total occlusion (CTO). The origin of collateral flow to the CTO segment has not been studied in regard to short-term mortality. This study examined the impact of collateral feeding donor arteries from an infarct-related artery (IRA) or non-IRA to the comorbid CTO segment in regard to STEMI short-term mortality.Data from 760 consecutive STEMI patients who underwent primary percutaneous coronary intervention were obtained retrospectively from medical records. The number of vessels involved and origin of the collateral feeding donor artery were evaluated using angiograms from the primary percutaneous coronary intervention. The study population was divided into patients with: single-vessel disease (SVD) (n=483), MVD without CTO (n=208), and MVD with CTO (n=64). All CTO segments had collateral flow from an IRA (n=23) or non-IRA (n=46). All-cause mortality (30-day) was analyzed.Compared to SVD and MVD without CTO, MVD with comorbid CTO had a higher mortality (5.4% vs. 15.9% vs. 24.6%, P0.0001, respectively). Of patients with CTO, those with collateral flow from the IRA had significantly higher mortality than the non-IRA group (52.2% vs. 10.9%, P0.0001). Collateral flow from the IRA was extracted as an independent predictor associated with 30-day all-cause mortality using a multivariate Cox proportional hazards model (hazard ratio 4.71, 95% confidence interval 1.60-14.2, P=0.0005).The origin of the collateral donor artery from the IRA had an impact on short-term mortality in STEMI patients with comorbid CTO lesions. |
| Databáze: | OpenAIRE |
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