Mid-Term Clinical Outcomes According to CTO Revascularization Status in Patients With NSTEMI and Multivessel Disease.
7 affiliations
- 1Department of Cardiology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China.
- 2Department of Cardiology, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu, China.
- 3Department of Ultrasonography, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu, China.
- 4Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.
- 5Department of Cardiology, Cangzhou People's Hospital, Cangzhou, Hebei, China.
- 6Department of Information Center, Yuncheng Central Hospital, Yuncheng, Shanxi, China.
- 7Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China.
Abstract
Background
The clinical relevance of chronic total occlusion (CTO) revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.Methods
In this multicenter retrospective cohort study, 632 patients with NSTEMI, MVD, and CTO were included. Patients were categorized into a complete revascularization group involving successful CTO recanalization (CR-CTO, n = 119) and an incomplete revascularization group without successful CTO recanalization (ICR-CTO, n = 513). The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE).Results
During a mean follow-up of 528 ± 201 days, the incidences of MACCE (11.8% vs. 28.5%) and MACE (7.6% vs. 24.2%) were significantly lower in the CR-CTO group than in the ICR-CTO group (both p < 0.001). In multivariable Cox regression analyses, CR-CTO was independently associated with lower risks of MACCE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.20-0.61) and MACE (HR, 0.26; 95% CI, 0.13-0.51). Among patients without successful CTO recanalization, additional revascularization of non-CTO lesions was not associated with improved outcomes.Conclusions
In patients with NSTEMI, MVD, and CTO, complete revascularization involving successful CTO recanalization was associated with improved mid-term clinical outcomes. In contrast, additional revascularization of non-CTO lesions alone was not associated with a prognostic benefit when CTO lesions remained unrevascularized. These findings suggest that CTO revascularization status may warrant specific consideration when revascularization strategies are evaluated in this patient population.
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BibTeX
@article{liu2026midterm,
title = {{Mid-Term Clinical Outcomes According to CTO Revascularization Status in Patients With NSTEMI and Multivessel Disease.}},
author = {Wei Liu and Yuling Li and Wei Qin and Jixian Gao and Bo Liu and Chongyou Rao and Bing Han},
journal = {Clinical cardiology},
year = {2026},
month = oct,
doi = {10.1002/clc.70491},
url = {https://europepmc.org/article/MED/42910468},
note = {CC BY},
}
RIS
TY - JOUR
TI - Mid-Term Clinical Outcomes According to CTO Revascularization Status in Patients With NSTEMI and Multivessel Disease.
AU - Wei Liu
AU - Yuling Li
AU - Wei Qin
AU - Jixian Gao
AU - Bo Liu
AU - Chongyou Rao
AU - Bing Han
PY - 2026
DA - 2026/10/01
JO - Clinical cardiology
DO - 10.1002/clc.70491
UR - https://europepmc.org/article/MED/42910468
AB - Background The clinical relevance of chronic total occlusion (CTO) revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.Methods In this multicenter retrospective cohort study, 632 patients with NSTEMI, MVD, and CTO were included. Patients were categorized into a complete revascularization group involving successful CTO recanalization (CR-CTO, n = 119) and an incomplete revascularization group without successful CTO recanalization (ICR-CTO, n = 513). The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE).Results During a mean follow-up of 528 ± 201 days, the incidences of MACCE (11.8% vs. 28.5%) and MACE (7.6% vs. 24.2%) were significantly lower in the CR-CTO group than in the ICR-CTO group (both p < 0.001). In multivariable Cox regression analyses, CR-CTO was independently associated with lower risks of MACCE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.20-0.61) and MACE (HR, 0.26; 95% CI, 0.13-0.51). Among patients without successful CTO recanalization, additional revascularization of non-CTO lesions was not associated with improved outcomes.Conclusions In patients with NSTEMI, MVD, and CTO, complete revascularization involving successful CTO recanalization was associated with improved mid-term clinical outcomes. In contrast, additional revascularization of non-CTO lesions alone was not associated with a prognostic benefit when CTO lesions remained unrevascularized. These findings suggest that CTO revascularization status may warrant specific consideration when revascularization strategies are evaluated in this patient population.
SN - 0160-9289
SN - 1932-8737
ER -