Chronic total occlusion and outcomes after out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction.

BACKGROUND: Out-of-hospital cardiac arrest in the setting of ST-segment elevation myocardial infarction is associated with high death rates. Chronic total occlusions are frequent in coronary artery disease, and have been linked to poor outcomes in acute coronary syndromes, but their prognostic impact in patients with out-of-hospital cardiac arrest in the setting of ST-segment elevation myocardial infarction is unclear.

AIM: To evaluate the prognostic impact of coronary chronic total occlusions in patients resuscitated from out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction.

METHODS: We analysed data from the prospective PROCAT registry including consecutive patients with out-of-hospital cardiac arrest with return of spontaneous circulation and ST-segment elevation myocardial infarction who underwent emergent coronary angiography between 2007 and 2024. The presence of chronic total occlusion was assessed at baseline. The primary endpoint was 90-day all-cause death; secondary endpoints included in-hospital death. Logistic regression and Cox models were used to assess associations between chronic total occlusion and outcomes.

RESULTS: Among 352 patients included, chronic total occlusion was present in 58 (16%). Patients with chronic total occlusion were older, had more co-morbidities and exhibited more extensive coronary artery disease. Rates of in-hospital death (55.2% vs. 39.8%; P=0.030) and 90-day death (69.0% vs. 49.0%; P=0.005) were higher in the chronic total occlusion group. In the univariate analysis, chronic total occlusion was associated with increased in-hospital deaths (odds ratio: 1.86, 95% confidence interval: 1.05-3.29) and 90-day deaths (hazard ratio: 1.76, 95% confidence interval: 1.18-2.62). However, after multivariable adjustment for clinical and resuscitation-related factors, chronic total occlusion was not independently associated with either endpoint.

CONCLUSIONS: In patients resuscitated from out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction, chronic total occlusion is associated with increased crude death rates, but does not independently predict outcomes after adjustment. Chronic total occlusion probably reflects a higher atherosclerotic burden rather than being a direct driver of early death. The detection of chronic total occlusion remains clinically relevant for long-term management.