Coronary Chronic Total Occlusions in the Setting of Acute Myocardial Infarction

*Bimmer Claessen, Loes Hoebers, José Henriques

Department of Cardiology, Academic Medical Center, University of Amsterdam,
Amsterdam, the Netherlands
*Correspondence to

Disclosure: No potential conflict of interest.
Received: 17.03.14 Accepted: 16.04.14
Citation: EMJ Int Cardiol. 2014;1:38-43.


Approximately 10-15% of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) are found to have a chronic total occlusion (CTO) in a non-infarct related artery (IRA). The presence of a coronary CTO in a non-IRA in STEMI patients is associated with increased mortality and above average deterioration of left ventricular function. A number of mechanisms may be responsible for this worsened prognosis, including impaired healing at the infarct border zone, decreased protection against future cardiovascular events, and potentially increased risk of arrhythmias. This review article aims to provide an overview of published data on the prognostic effect of CTOs in a non-IRA in the setting of primary PCI for acute STEMI. Additionally, observational data on staged PCI of CTOs after primary PCI, and future studies on additional CTO PCI after primary PCI, will be reviewed.

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