Impact of total occlusion of an infarct-related artery on long-term mortality in acute non-ST-elevation myocardial infarction patients who underwent early percutaneous coronary intervention.

Some patients with non-ST-elevation myocardial infarction (NSTEMI) have a total occlusive infarct-related artery. However, the long-term prognosis of these patients is uncertain, particularly for those who underwent an early invasive strategy. The aim of this study was to determine the clinical impact of total occlusion (TO) of an infarct-related artery (IRA) in these patients. A total of 2,094 patients with NSTEMI who underwent an early invasive strategy with percutaneous coronary intervention (PCI) in the Korea Acute MI Registry (KAMIR) were analyzed (TO group; 665 patients, and non-TO group; 1,429 patients).In-hospital and one-year clinical outcomes were compared between the two groups. The left circumflex (42.9%) and right coronary artery (31.9%) were the major IRA in the TO group, while the left anterior descending artery was more common as an IRA in the non-TO group (44.1%). In-hospital complications including death and cardiogenic shock occurred frequently in the TO group. Also, the rates of one-month and 12-month adverse cardiac outcomes were higher in the TO group. In the Cox-proportional hazard model, TO in IRA predicted 12-month all-cause death. In conclusion, NSTEMI patients with TO in IRA showed worse short- and long-term clinical outcomes compared with those of non-TO patients.