The role of chronic total occlusions in non-infarct-related arteries in acute coronary syndrome patients: a systematic review.

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Future cardiology Pub Date : 2024-01-01 Epub Date: 2024-10-09 DOI:10.1080/14796678.2024.2406651
Hussein Sliman, Rim Kasem Ali Sliman, Paul Knaapen, Alex Nap, Jose Henriques, Niels Verouden, Bimmer EPM Claessen
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Abstract

Aim: This systematic review evaluated the impact of a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) on clinical outcomes in acute coronary syndrome (ACS) patients and assessed the benefits of staged revascularization.Methods: We performed a comprehensive systematic review to provide further insight into the impact of a CTO in a non-IRA on clinical outcomes after ACS. Moreover, we review the currently available evidence on the clinical significance of staged revascularization for a CTO in a non-IRA patients with ACS and propose whether prophylactic CTO percutaneous coronary intervention (PCI) could improve outcomes in patients who subsequently develop an ACS.Results: Our search identified 999 studies, from which 30 were selected and ten were included in the analysis. The results showed a trend of higher all-cause mortality and major adverse cardiac event rates in the culprit-only-PCI group compared with the multivessel (MV)-PC I group in ST elevation myocardial infarction patients, with varying statistical significance across different outcomes.Conclusion: This review highlights the significant impact of non-IRA CTOs in ACS. Successful CTO revascularization may provide benefits, particularly in ST elevation myocardial infarction, but the optimal management approach remains uncertain. The presence of a non-IRA CTO, especially in cardiogenic shock, predicts worse outcomes. Further research is warranted to determine the effective strategies to improve survival.

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急性冠状动脉综合征患者非梗死相关动脉慢性全闭塞的作用:系统综述。
目的:本系统性综述评估了非梗死相关动脉(非IRA)慢性全闭塞(CTO)对急性冠状动脉综合征(ACS)患者临床预后的影响,并评估了分阶段血管重建的益处:我们进行了一项全面的系统综述,以进一步了解非 IRA 中的 CTO 对 ACS 后临床预后的影响。此外,我们还回顾了目前关于对非 IRA ACS 患者的 CTO 进行分期血管再通的临床意义的现有证据,并提出了预防性 CTO 经皮冠状动脉介入治疗(PCI)是否能改善随后发生 ACS 的患者的预后:我们的搜索发现了 999 项研究,从中筛选出 30 项,10 项纳入分析。结果显示,在ST段抬高的心肌梗死患者中,与多血管(MV)-PC I组相比,单纯罪魁祸首-PCI组的全因死亡率和主要不良心脏事件发生率呈上升趋势,不同结果的统计学意义各不相同:本综述强调了非IRA CTO对ACS的重大影响。成功的 CTO 血管再通可带来益处,尤其是在 ST 波抬高型心肌梗死中,但最佳的管理方法仍不确定。非 IRA CTO 的存在,尤其是在心源性休克时,预示着较差的预后。有必要开展进一步研究,以确定提高存活率的有效策略。
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来源期刊
Future cardiology
Future cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.80
自引率
5.90%
发文量
87
期刊介绍: Research advances have contributed to improved outcomes across all specialties, but the rate of advancement in cardiology has been exceptional. Concurrently, the population of patients with cardiac conditions continues to grow and greater public awareness has increased patients" expectations of new drugs and devices. Future Cardiology (ISSN 1479-6678) reflects this new era of cardiology and highlights the new molecular approach to advancing cardiovascular therapy. Coverage will also reflect the major technological advances in bioengineering in cardiology in terms of advanced and robust devices, miniaturization, imaging, system modeling and information management issues.
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