Abstract 16703: ST Elevation Myocardial Infarction and Chronic Total Occlusion: Trends and In-Hospital Outcomes in the United States

Introduction: Acute ST-segment elevation myocardial infarction (STEMI) occurs due to sudden thrombotic complete occlusion of one or more coronary arteries resulting in transmural ischemia and eventually necrosis. Chronic total occlusions (CTO) are incidentally found in a minority of patients and have been implicated in poor outcomes in STEMI patients. There is a paucity of data analyzing the trends and outcomes of STEMI patients with a CTO (STEMI-CTO).

Methods: We used the National Inpatient Sample to identify elderly (>65 years) STEMI patients with vs. without CTO. We compared the prevalence trends of STEMI, baseline characteristics, in-hospital mortality, and complications, including cardiogenic shock, in these two groups from 2016 to 2019. Chi-square test was used to determine the statistical significance of these variables.

Results: Of 317,105 STEMI hospitalizations, 21,115 had concomitant CTO. Patients with CTO were more likely to be young (median age 73 vs. 74, p <0.001), obese (13.8% vs. 12.8%), males (67.5% vs. 60.5%), with peripheral vascular disease (13.4% vs. 10.8%), hyperlipidemia (67.5% vs. 65.5%), and prior history of MI (15.2% vs. 12.3%), PCI (14.1% vs. 13.0%) and CABG (9.4% vs. 6.1%) (p<0.001). In-hospital mortality was more frequent in CTO-STEMI compared to non-CTO-STEMI patients (12.5% vs. 11.8%, p=0.003). From 2016-2019, the prevalence of CTO kept decreasing (10.7% vs. 6.5%, P<0.001); however, increasing mortality trends in CTO patients (14.4% vs. 12.2%) compared to decreasing mortality trends in non-CTO patients (11.2% vs. 12.5%) was concerning. [Fig. 1]. Also, the frequency of in-hospital deaths was on a uptrend and peaked in 2019 amongst all CTO patients.

Conclusions: The prevalence of CTO in STEMI patients is decreasing, while in-hospital mortality, cardiogenic shock and hospital expenses continue to rise. Future prospective studies are necessary to understand the trends among CTO-STEMI patients to avoid poor outcomes.