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目的:评估接受急诊介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者同时合并慢性闭塞病变（CTO）时其近远期预后。方法:研究纳入中国急性心肌梗死患者前瞻性注册研究中接受急诊PCI的11 905例STEMI患者，根据造影结果分为合并CTO组和不合并CTO组。收集2组的基线临床资料，并根据基线资料进行1∶3倾向评分匹配。对2组患者进行随访，主要研究终点为住院期间和术后1年死亡率，次要研究终点为1年时的总心血管不良事件率，包括死亡、再发心肌梗死、再次血运重建、心力衰竭（心衰）再入院、卒中、严重出血等。结果:合并CTO的患者STEMI共931例，男性755例（81.1%），年龄（62.2±11.4）岁，占所有STEMI患者的7.8%。非合并CTO的STEMI患者共10 974例，男性8 829例（80.5%），年龄（60.0±11.8）岁。进行倾向评分匹配后STEMI合并CTO组纳入896例患者，STEMI不合并CTO组纳入2 688例患者，与不合并CTO组相比，STEMI合并CTO组住院期间死亡率较高（4.2%比2.4%，n P=0.006），随访1年期间全因死亡率（8.5%比4.4%，n P<0.001）、心原性死亡率（5.3%比2.6%，n P=0.001）和总MACE发生率（35.1%比23.3%，n P<0.001）较高。多因素logistic回归分析提示合并CTO（n HR=1.54，95%n CI 1.06~2.22，n P=0.022）、高龄（n HR=1.06，95%n CI 1.04~1.08，n P<0.001）和既往存在心衰病史（n HR=4.10，95%n CI 1.90~8.83，n P<0.001）是接受急诊PCI的STEMI患者术后1年死亡的独立危险因素。n 结论:合并CTO的STEMI患者住院期间和1年死亡率较高，合并CTO、高龄和既往存在心衰病史是STEMI患者1年死亡的独立危险因素。“,”Objective:To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction (STEMI) concurrent with chronic total occlusion (CTO) undergoing primary percutaneous coronary intervention (PCI).Methods:11 905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI. 1∶3 propensity score matching was used to match the patients between the two groups. The primary endpoint was in-hospital mortality and mortality at 1-year post PCI. The secondary endpoint was major adverse cardiovascular events (MACE) including death, re-myocardial infarction, revascularization, heart failure associated readmission, stroke and major bleeding at 1-year post PCI.Results:There were 931 CTO patients (7.8%) in this cohort (male=755 (81.1%), mean age (62.2±11.4 years)). The rest 10 974 patients were STEMI without CTO (male=8 829 (80.5%),mean age (60.0±11.8) years). After propensity score matching, 896 patients were enrolled in CTO group and 2 688 in non-CTO group. In-hospital mortality was significantly higher in the CTO group than in non-CTO group (4.2% vs. 2.4%, n P=0.006). The ratio of all cause death, cardiac death, and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group (8.5% vs. 4.4%, n P<0.001, 5.3% vs. 2.6%, n P=0.001, 35.1% vs. 23.3%, n P<0.001, respectively). Multiple regression analysis showed that CTO (n HR=1.54, 95%n CI 1.06-2.22, n P=0.022), advanced age (n HR=1.06, 95%n CI 1.04-1.08, n P<0.001), and previous heart failure history (n HR=4.10, 95%n CI 1.90-8.83, n P<0.001) were independent risk factors of 1-year mortality.n Conclusions:The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO. CTO, advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.