Impact of Total Coronary Occlusion on Long-term Outcomes in Patients with ST-segment Elevation Myocardial Infarction

Purpose: This study aimed to investigate the impact of preprocedural total coronary occlusion on long-term cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI) in the contemporary percutaneous coronary intervention (PCI) era.Methods: Of 13,707 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, 2,920 consecutive patients with STEMI having single-vessel disease within 48 hours of symptom onset who underwent primary PCI were categorized by preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade: 0 (n = 1,966), I or II (n = 583), and III (n = 371). Co-primary outcomes were all-cause death and major adverse cardio-cerebrovascular event (MACCE) at 3 years.Results: Patients with preprocedural TIMI flow grade 0 were more likely to have longer symptom-to-door time, higher body weight, higher Killip class, lower left ventricular ejection fraction, higher peak troponin I, and lower postprocedural TIMI flow grade 3 (94.5% vs. 100%, P < 0.001) compared to those with preprocedural TIMI flow grade 3. Kaplan–Meier analysis showed no significant difference in all-cause mortality (8.1% in TIMI 0 vs. 5.9% in TIMI 3, log-rank P = 0.161) and MACCE (14.1% vs. 13.7%, log-rank P = 0.931) between the two groups. In a Cox time-to-event multivariable model with preprocedural TIMI flow grade 3 as the reference, the preprocedural TIMI flow grade 0 was not independently associated with mortality or MACCE.Conclusion: In a nationwide prospective Korean registry, total coronary occlusion before PCI was not associated with worse clinical outcomes at 3 years in patients with STEMI and single-vessel disease when treated with primary PCI.