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Chronically Occluded Coronary Artery in Patients Undergoing Acute Coronary Syndromes Worsens their Long-Term Prognosis

Leszek Majecki, Szymon  and Marek browski

Background: Comparison of patients with and without chronic total occlusion in a non-infarct related artery (non-IRA) and the coronary artery dominance type in terms of clinical characteristics and impact on the degree of left ventricular dysfunction and long term survival.

Material and findings: There were 402 consecutive patients with multi-vessel disease, who had undergone percutaneous coronary intervention because of acute coronary syndrome, enrolled in this study. As many as 33.8% of patients had at least one chronic total occlusion in non-IRA. Left coronary artery dominance was present in 10.95% of patients only, and 83.58% of them showed right coronary artery dominance. Patients with chronic total occlusion were at higher risk because of age and comorbidity.

An ST-segment elevation myocardial infarction occurred more often in all patients without chronic total occlusion, while patients with non-IRA chronic total occlusion more frequently presented with an-ST-segment elevation myocardial infarction. No fewer than 48.5% of patients with chronic total occlusion had at least moderate left ventricular dysfunction while in patients without chronic total occlusion the number reached 25.56% only (p = 0.02). No significant differences were observed between patients with right dominance vs left dominance (p = 0.9).

The average 466-day mortality in 402 patients with multivessel disease was 13.18%. Among patients with chronic total occlusion, all cause and cardiovascular mortality were 17% and 12.5%, while in patients without chronic total occlusion 11% and 9%, respectively (p = 0.2 and p = 0.4). In patients with left dominance vs right dominance it was 20.5% and 16% vs 13.1% and 9.8%, respectively (p = 0.36 and p = 0.4).

Conclusions: The main factor that influences prognosis is the presence of chronic total occlusion in a non-infarct related artery rather than the coronary artery dominance type. However, the presence of left dominance may be an additional adverse cardiovascular risk factor.