Chronic total occlusion and outcomes after out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction - 26/08/26
, Andrea Cupiraggi a, Thibault Gasparato a, Alain Cariou b, c, Olivier Varenne a, b, Manveer Singh a, d, 1, Fabien Picard a, b, e, 1Graphical abstract |
Highlights |
• | CTO was identified in 16% of patients resuscitated from OHCA with STEMI. |
• | Patients with CTO had more co-morbidities and more extensive CAD. |
• | Significantly higher crude in-hospital and 90-day death rates in patients with CTO. |
• | After multivariable adjustment, CTO was not independently associated with death. |
• | CTO should be considered a marker of advanced coronary atherosclerosis. |
• | CTO should not be considered a direct determinant of early death. |
Abstract |
Background |
Out-of-hospital cardiac arrest in the setting of ST-segment elevation myocardial infarction is associated with high death rates. Chronic total occlusions are frequent in coronary artery disease, and have been linked to poor outcomes in acute coronary syndromes, but their prognostic impact in patients with out-of-hospital cardiac arrest in the setting of ST-segment elevation myocardial infarction is unclear.
Aim |
To evaluate the prognostic impact of coronary chronic total occlusions in patients resuscitated from out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction.
Methods |
We analysed data from the prospective PROCAT registry including consecutive patients with out-of-hospital cardiac arrest with return of spontaneous circulation and ST-segment elevation myocardial infarction who underwent emergent coronary angiography between 2007 and 2024. The presence of chronic total occlusion was assessed at baseline. The primary endpoint was 90-day all-cause death; secondary endpoints included in-hospital death. Logistic regression and Cox models were used to assess associations between chronic total occlusion and outcomes.
Results |
Among 352 patients included, chronic total occlusion was present in 58 (16%). Patients with chronic total occlusion were older, had more co-morbidities and exhibited more extensive coronary artery disease. Rates of in-hospital death (55.2% vs. 39.8%; P = 0.030) and 90-day death (69.0% vs. 49.0%; P = 0.005) were higher in the chronic total occlusion group. In the univariate analysis, chronic total occlusion was associated with increased in-hospital deaths (odds ratio: 1.86, 95% confidence interval: 1.05–3.29) and 90-day deaths (hazard ratio: 1.76, 95% confidence interval: 1.18–2.62). However, after multivariable adjustment for clinical and resuscitation-related factors, chronic total occlusion was not independently associated with either endpoint.
Conclusions |
In patients resuscitated from out-of-hospital cardiac arrest with ST-segment elevation myocardial infarction, chronic total occlusion is associated with increased crude death rates, but does not independently predict outcomes after adjustment. Chronic total occlusion probably reflects a higher atherosclerotic burden rather than being a direct driver of early death. The detection of chronic total occlusion remains clinically relevant for long-term management.
Le texte complet de cet article est disponible en PDF.Keywords : Out-of-hospital cardiac arrest, Chronic total occlusion, STEMI
Plan
Vol 119 - N° 8-9
P. 536-544 - août 2026 Retour au numéro
Article précédent
- When angiography starts speaking the language of the myocardium
- Ikram El Marzouki, Gilles Barone-Rochette
- Electrocardiographic phenotypes of a representative subset of the French general population: ECGs at inclusion in the CONSTANCES cohort
- Fabrice Extramiana, Thien Vu Nguyen Minh Tuan, Martino Vaglio, Anna Ozguler, Peter W. Macfarlane, Pierre Maison-Blanche, Fabio Badilini
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?