Abstract 938 Prognostic Impact of Chronic Total Occlusion in Patients with Cardiogenic Shock

Objective: This study aims to investigate the prognostic impact of chronic total occlusion (CTO) in patients with cardiogenic shock (CS).

Background: Limited data with respect to the prognostic impact of CTO in CS patients is available.

Methods: Consecutive patients admitted to an internistic invasive care unit (ICU) due to CS were monocentrically included from 2019 to 2021. The prognostic impact of CTO regarding 30-day all-cause mortality was analyzed within the entire study cohort as well as stratified for the presence of acute myocardial infarction (AMI). Statistical analyzes included univariable t-tests, Mann-Whitney U tests, Kaplan-Meier analyzes and Cox proportional regression analyzes

Results: Out of 192 CS patients undergoing coronary angiography, 24% (n=47) presented with at least one CTO. Most patients presented with CTO of the right coronary artery (RCA) (51%), followed by the left anterior descending artery (LAD) (32%). The overall risk of 30-day all-cause mortality was 53%. Patients with CTO were associated with an increased risk of 30-day all-cause mortality compared to non-CTO patients (69% vs. 48%; log rank p=0.007; HR=1.708; 95% CI 1.127-2.589; p=0.012), even after multivariable adjustment (HR=2.246; 95% CI 1.366-3.692; p=0.001). Furthermore, in CS patients with AMI, CTO was accompanied by a heightened risk of 30-day all-cause mortality (79% vs. 56%; log rank p=0.022; HR=1.659; 95% CI 1.042-2.640; p=0.033), whereas this association was not found in patients with non-AMI (43% vs. 32%; log rank p=0.327; HR=1.582; 95% CI 0.618-4.046; p=0.339).

Conclusion: CTO deteriorates prognosis in CS patients admitted to an internistic ICU.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Prognostic Impact of Chronic Total Occlusion in Patients with Cardiogenic Shock
T. Schupp¹, J. Forner¹, J. Rusnak¹, K. J. Weidner¹, M. Ruka², S. Egner-Walter¹, T. Bertsch³, K. A. Mashayekhi⁴, M. Ayoub⁵, I. Akin¹, M. Behnes¹
¹I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; ²Medizinische Klinik II, Universitätsklinikum Mannheim, Mannheim; ³Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg; ⁴Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr/Schwarzwald; ⁵Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;
Objective: This study aims to investigate the prognostic impact of chronic total occlusion (CTO) in patients with cardiogenic shock (CS). Background: Limited data with respect to the prognostic impact of CTO in CS patients is available. Methods: Consecutive patients admitted to an internistic invasive care unit (ICU) due to CS were monocentrically included from 2019 to 2021. The prognostic impact of CTO regarding 30-day all-cause mortality was analyzed within the entire study cohort as well as stratified for the presence of acute myocardial infarction (AMI). Statistical analyzes included univariable t-tests, Mann-Whitney U tests, Kaplan-Meier analyzes and Cox proportional regression analyzes Results: Out of 192 CS patients undergoing coronary angiography, 24% (n=47) presented with at least one CTO. Most patients presented with CTO of the right coronary artery (RCA) (51%), followed by the left anterior descending artery (LAD) (32%). The overall risk of 30-day all-cause mortality was 53%. Patients with CTO were associated with an increased risk of 30-day all-cause mortality compared to non-CTO patients (69% vs. 48%; log rank p=0.007; HR=1.708; 95% CI 1.127-2.589; p=0.012), even after multivariable adjustment (HR=2.246; 95% CI 1.366-3.692; p=0.001). Furthermore, in CS patients with AMI, CTO was accompanied by a heightened risk of 30-day all-cause mortality (79% vs. 56%; log rank p=0.022; HR=1.659; 95% CI 1.042-2.640; p=0.033), whereas this association was not found in patients with non-AMI (43% vs. 32%; log rank p=0.327; HR=1.582; 95% CI 0.618-4.046; p=0.339). Conclusion: CTO deteriorates prognosis in CS patients admitted to an internistic ICU.
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