Aims Previous studies indicated that a chronic total occlusion (CTO) in a non-infarct-related artery is linked to higher mortality mainly in the acute setting in patients with ST-elevation myocardial infarction (STEMI). Our aim was to assess the temporal distribution of mortality risk associated with non-culprit CTO over years after STEMI. Methods and results The study included 8679 STEMI patients treated with primary percutaneous coronary intervention (PCI). Kaplan–Meier cumulative mortality curves for non-culprit CTO vs. no CTO were compared with log-rank test, with landmarks set at 30 days and 1 year. Adjusted Cox regression models were constructed to assess the impact of non-culprit CTO on mortality over different time intervals. Tests for interaction were pre-specified between non-culprit CTO and acute heart failure and left ventricular ejection fraction. The primary outcome variable was all-cause mortality, and the median follow-up was 5 years. Non-culprit CTO was present in 11.6% of patients (n = 1010). Presence of a CTO was associated with increased early [30-day adjusted hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.54–2.36; P < 0.001] and late mortality (5-year adjusted HR 1.66, 95% CI 1.42–1.95; P < 0.001). Landmark analyses revealed an annual two-fold increase in mortality in patients with vs. without a CTO after the first year of follow-up. The observed pattern of mortality increase over time was independent of acute or chronic LV impairment. Conclusions Non-culprit CTO is independently associated with mortality over 5 years after primary PCI for STEMI, with a constant annual two-fold increase in the risk of death beyond the first year of follow-up.

中文翻译：

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经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者非肇事慢性完全闭塞随时间推移对预后的影响

目标 先前的研究表明，非梗塞相关动脉的慢性完全闭塞 (CTO) 与 ST 段抬高型心肌梗塞 (STEMI) 患者的急性期死亡率升高有关。我们的目的是评估 STEMI 后数年与非罪犯 CTO 相关的死亡风险的时间分布。方法和结果 本研究纳入了 8679 名接受初次经皮冠状动脉介入治疗 (PCI) 治疗的 STEMI 患者。将非罪犯 CTO 与无 CTO 的 Kaplan-Meier 累积死亡率曲线与对数秩检验进行比较，标志设定为 30 天和 1 年。构建调整后的 Cox 回归模型以评估非罪犯 CTO 在不同时间间隔内对死亡率的影响。预先指定了非罪犯 CTO 与急性心力衰竭和左心室射血分数之间的相互作用测试。主要结果变量是全因死亡率，中位随访时间为 5 年。11.6% 的患者（n = 1010）存在非罪犯 CTO。CTO 的存在与早期增加相关 [30 天调整风险比 (HR) 1.91，95% 置信区间 (CI) 1.54-2.36；P＜0.001] 和晚期死亡率（5 年调整后 HR 1.66，95% CI 1.42–1.95；P < 0.001）。里程碑分析显示，在随访的第一年之后，有 CTO 的患者与没有 CTO 的患者的死亡率每年增加两倍。观察到的死亡率随时间增加的模式与急性或慢性 LV 损伤无关。