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Chronic total occlusions in non-infarct-related arteries

Debabrata Mukherjee, Marco Roffi
DOI: http://dx.doi.org/10.1093/eurheartj/ehr412 695-697 First published online: 27 January 2012

This editorial refers to ‘Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial’, by B.E. Claessen et al., on page 768

Chronic total occlusions (CTOs) are complete obstructions of coronary arteries, described as ≥99% stenosis, of >3 months duration, and with poor or no antegrade blood flow, i.e. TIMI flow grade 0–1. Patients with CTOs are frequently encountered in interventional cardiology practice. It has been estimated that one-third of patients with coronary artery disease requiring revascularization have a CTO, and that ∼10–20% of lesions intended for percutaneous revascularization are complete occlusions.1 In stable coronary artery disease, the negative impact of a CTO has been demonstrated. A New York State survey showed that incomplete percutaneous revascularization leaving untreated CTOs led to higher 3-year mortality.2 In the setting of primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI), previous studies have suggested that the increased mortality observed in patients with multivessel disease (MVD) was mainly driven by the presence of a CTO in a non-infarct-related artery (IRA).3,4 Furthermore, STEMI patients with a CTO in a non-IRA were found to have suboptimal reperfusion more frequently, as shown by lower myocardial blush grades and a lesser degree of ST-segment resolution following pPCI.5

Claessen et al.6 have retrospectively evaluated 3283 STEMI patients undergoing pPCI within the HORIZONS-AMI trial and confirmed the worse prognosis of patients with a CTO in a non-IRA …