Mid-Term Clinical Outcomes According to CTO Revascularization Status in Patients With NSTEMI and Multivessel Disease.

BACKGROUND

The clinical relevance of chronic total occlusion (CTO) revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.

METHODS

In this multicenter retrospective cohort study, 632 patients with NSTEMI, MVD, and CTO were included. Patients were categorized into a complete revascularization group involving successful CTO recanalization (CR-CTO, n = 119) and an incomplete revascularization group without successful CTO recanalization (ICR-CTO, n = 513). The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE).

RESULTS

During a mean follow-up of 528 ± 201 days, the incidences of MACCE (11.8% vs. 28.5%) and MACE (7.6% vs. 24.2%) were significantly lower in the CR-CTO group than in the ICR-CTO group (both p < 0.001). In multivariable Cox regression analyses, CR-CTO was independently associated with lower risks of MACCE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.20-0.61) and MACE (HR, 0.26; 95% CI, 0.13-0.51). Among patients without successful CTO recanalization, additional revascularization of non-CTO lesions was not associated with improved outcomes.

CONCLUSIONS

In patients with NSTEMI, MVD, and CTO, complete revascularization involving successful CTO recanalization was associated with improved mid-term clinical outcomes. In contrast, additional revascularization of non-CTO lesions alone was not associated with a prognostic benefit when CTO lesions remained unrevascularized. These findings suggest that CTO revascularization status may warrant specific consideration when revascularization strategies are evaluated in this patient population.