Incidence of In-Hospital MACE in Patients Presented with Acute STEMI in the Presence of CTO in Non-IRA

Abstract Background: In STEMI patients, the presence of CTO in non-IRA has been associated with worse prognosis and adverse outcomes in many studies, whether in the short term or long term. This has been thought to be due to many factors includ-ing more major comorbidities in CTO patients, higher ischemic burden, and the “double Jeopardy theory”. Aim of Study: The aim of our study is to evaluate the inci-dence of in-hospital MACE in patients presenting with STEMI and CTO in non-IRA. Patients and Methods: We analyzed 111 patients (52 pa-tients with CTO in non-IRA and 59 without CTO in non-IRA) to compare their clinical outcomes in Ain Shams University Hospitals. Although it was not found to be statistically significant, we did find that the incidence of In-hospital MACE is higher in cases with CTO in non-IRA in comparison to cases with-out CTO in non-IRA including single vessel disease patients and multi-vessel disease patients. Acute Pulmonary Edema and Cardiogenic Shock were found to be significantly higher in cas-es with CTO in non-IRA. 50% of cases with CTO developed MACE; and 100% of the CTO cases that developed MACE had reduced ejection fraction. Results: This study showed that the majority of patients were males, smokers, hypertensive, and that all the involved patients in the study were dyslipidemic. In the majority of the cases the culprit was LAD as they mostly presented with An-terior STEMI. Conclusion: In patients presenting with STEMI, acute pul-monary oedema and cardiogenic shock incidence was signifi-cantly higher in cases undergoing primary PCI with CTO in non-IRA compared to cases without CTO in non-IRA (either single vessel disease patients and multi-vessel disease). In-hos-pital MACE incidence was still higher yet not statistically sig-nificant in patients with CTO in non-IRA.