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

We sought to investigate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) on mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In the HORIZONS-AMI trial, of 3283 patients undergoing primary PCI, 1524 patients (46.4) had single-vessel disease (SVD), 1477 (45.0) had MVD without a CTO, and 283 (8.6) had MVD with a CTO in a non-IRA. Compared with SVD patients and MVD patients without a CTO, patients with a non-IRA CTO were significantly less likely to achieve post-procedural TIMI 3 flow (P 0.0003), more often had absent myocardial blush (P 0.0002), and less frequently achieved complete ST-segment resolution (P 0.0001). By multivariable analysis, MVD with CTO in a non-IRA was an independent predictor of both 0- to 30-day mortality [hazard ratio (HR) 2.88, 95 confidence interval (CI) 1.415.88, P 0.004] and 30-day to 3-year mortality (HR 1.98, 95 CI 1.193.29, P 0.009), while MVD without a CTO was a significant predictor for 0- to 30-day mortality (HR 2.20, 95 CI 1.003.06, P 0.049) but not late mortality. In patients with STEMI undergoing primary PCI in the HORIZONS-AMI trial, MVD with or without a CTO in a non-IRA was an independent predictor of early mortality. The presence of a CTO in a non-IRA was also an independent predictor of increased late mortality to 3 years.