Abstract
Byline: Muhammad Junaid Ahsan, MercyOne, Iowa heart Cntr, west desmoines, IA; Noman Lateef, Univ of Nebraska Med Cent, Omaha, NE; Soban Ahmad, IM, Vidant Med Cntr/East Carolina Univ, Greenville, NC; azka latif; Muhammad Zoraiz Ahsan, Fatima Memorial Hosp, Lahore, Pakistan; kainat faizi, Touro Univ, Las Vegas, NV; Mohsin M Mirza, Omaha, NE; Mark Tannenbaum, Iowa Heart Cntr, West Des Moines, IA; Sivakumar Ardhanari, Cary, NC; Andrew M Goldsweig, Univ of Nebraska Med Cntr, Omaha, NE Introduction: In patients with acute myocardial infraction (AMI), multivessel coronary artery disease (CAD) is associated with worse prognosis than single-vessel CAD. Several observational studies have reported worse clinical outcomes in AMI patients with non-infarct-related artery chronic total occlusion (n-IRA CTO). We performed a systematic review and meta-analysis to evaluate the prognostic significance of n-IRA CTO in patients with AMI. Methods: Systematic review was performed querying PubMed, Google Scholar, Cochrane and clinicaltrials.gov from Inception through May 2022. Studies comparing AMI patients with and without n-IRA CTO were included. Outcomes included in-hospital, 30-day and long-term mortality, cardiac mortality, major adverse cardiovascular events (MACE), and major bleeding. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. Results: Five prospective, eight retrospective and 3 subgroup analyses of randomized control trials (RCTs) (n-IRA CTO n=2,521, no CTO n=18,397) were identified. Presence of n-IRA CTO was associated with higher in-hospital (RR 2.86, 95% CI 1.77-4.62, p<0.0001, Figure A), 30-day (RR 2.54, 95% CI 1.66-3.89, p<0.00001, B) and long-term mortality (RR 2.32, 95% CI 1.81-2.99, p<0.00001, C), as well as increased risk for cardiac mortality (RR 2.24, 95% CI 1.79-2.81, p<0.0001, D), MACE (RR 1.51, 95% CI 1.32-1.74, p<0.0001, E), and major bleeding (RR 1.99, 1.16-3.41, p=0.01, F) when compared to AMI patients without n-IRA CTO. Conclusions: In AMI patients, the presence of n-IRA CTO is associated with increased mortality and morbidity. Future studies should evaluate whether intensive monitoring and specialized care can improve outcomes in these patients.