Abstract

Background

Chronic total occlusion (CTO) is a near-total blockage of a coronary artery often seen during percutaneous coronary intervention for acute coronary syndrome but not directly responsible for the event.

Methods

The national readmission database (2016-2020) was utilized to identify hospitalizations for STEMI, with LAD as the culprit. Cohorts were stratified based on the presence of the CTO. A Propensity Score Matching (PSM) model matched CTO and non-CTO cases. Pearson’s x2 test was applied to PSM-2 matched cohorts to compare outcomes.

Results

Among 98,213 hospitalizations for LAD-STEMI, About 5.53% (N: 5,704) had CTO. After propensity matching (N=3,197), patients with CTO had higher mortality (10.95 vs. 7.26%, p: <0.001), sudden cardiac arrest (14.29 vs. 11.57%, p<0.001), cardiogenic shock (23.80 vs. 18.07%, p<0.001), mechanical circulatory support use (20.39 vs. 15.57%, p<0.001), and CABG rates (7.2 vs. 6.5%, p<0.001), although rates of MI complications and PCI were similar in the two cohorts (p>0.05). CTO patients had similar readmission rates on 30- (10.72 vs. 10.20%, p=0.52) and 90-day (18.43 vs. 17.35%, p=0.33) intervals, similar LOS (3 vs. 3 days) & higher adjusted cost of hospitalization [$195,346 vs. $171,793, p<0.001]. Female gender (aOR: 1.16), DM (aOR: 1.27), ESKD (aOR: 1.27) & HF (aOR:1.39) were significant predictors of readmission while rehabilitation transfer was protective against readmissions (aOR:0.31) [p<0.001].

Conclusions

In LAD-STEMI hospitalizations, patients with CTO have higher mortality, complications, and resource utilization, although MI complications & 90-day readmission rates were similar.

Document Type

Meeting Abstract

Publication Date

5-2024

Publication Title

JSCAI

First Page

101525

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