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Sahu AK, Kazmi DH, Kaushik A. Is it Worthy Enough to Revascularize Chronically Occluded Coronaries? Cardiol Rev 2024; 32:338-347. [PMID: 36912530 DOI: 10.1097/crd.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Chronic total occlusions (CTOs) represent the "final frontier" of coronary interventions with the lowest procedural success rates and the most common reason for incomplete revascularization and referral to coronary artery bypass graft surgery (CABG). CTO lesions are not an infrequent finding during coronary angiography. They are often responsible for enhancing the complexity of the coronary disease burden thereby affecting the final interventional decision in the process. Notwithstanding the modest technical success of CTO-PCI, most of the earlier observational data demonstrated a clear survival benefit free of major cardiovascular events (MACE) in patients undergoing successful CTO revascularization. However, data from recent randomized trials fail to uphold the same survival advantage albeit, showing some trend toward improvement in left ventricular function, quality of life indicators and freedom from fatal ventricular arrythmia. Various guidance statements propose a well-defined role for CTO intervention in specific situations provided criterions for patient selection, appreciable inducible ischemia, myocardial viability and cost-risk-benefit analysis are met.
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Affiliation(s)
- Ankit Kumar Sahu
- From the Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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van Veelen A, Verstraelen TE, Somsen YBO, Elias J, van Dongen IM, Delnoy PPHM, Scholten MF, Boersma LVA, Maass AH, Strikwerda S, Firouzi M, Allaart CP, Vernooy K, Grauss RW, Tukkie R, Knaapen P, Zwinderman AH, Dijkgraaf MGW, Claessen BEPM, van Barreveld M, Wilde AAM, Henriques JPS. Impact of a Chronic Total Coronary Occlusion on the Incidence of Appropriate Implantable Cardioverter-Defibrillator Shocks and Mortality: A Substudy of the Dutch Outcome in ICD Therapy (DO-IT)) Registry. J Am Heart Assoc 2024; 13:e032033. [PMID: 38591264 PMCID: PMC11262490 DOI: 10.1161/jaha.123.032033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort. METHODS AND RESULTS This is a subanalysis of the nationwide Dutch-Outcome in ICD Therapy (DO-IT) registry of primary prevention ICD recipients in The Netherlands between September 2014 and June 2016 (n=1442). We identified patients with chronic ischemic heart disease (n=663) and assessed available coronary angiograms for CTO presence (n=415). Patients with revascularized CTOs were excluded (n=79). The primary end point was the composite of all-cause mortality and appropriate ICD shocks. Clinical follow-up was conducted for at least 2 years. A total of 336 patients were included, with an average age of 67±9 years, and 20.5% was female (n=69). An unrevascularized CTO was identified in 110 patients (32.7%). During a median follow-up period of 27 months (interquartile range, 24-32), the primary end point occurred in 21.1% of patients with CTO (n=23) compared with 11.9% in patients without CTO (n=27; P=0.034). Corrected for baseline characteristics including left ventricular ejection fraction, and the presence of a CTO was an independent predictor for the primary end point (hazard ratio, 1.82 [95% CI, 1.03-3.22]; P=0.038). CONCLUSIONS Within this nationwide prospective registry of primary prevention ICD recipients, the presence of an unrevascularized CTO was an independent predictor for the composite outcome of all-cause mortality and appropriate ICD shocks.
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Affiliation(s)
- Anna van Veelen
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Tom E. Verstraelen
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Yvemarie B. O. Somsen
- Department of CardiologyAmsterdam UMC, VU University, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Joëlle Elias
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Ivo M. van Dongen
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | | | - Marcoen F. Scholten
- Department of CardiologyThorax Center Twente, Medisch Spectrum TwenteEnschedeThe Netherlands
| | - Lucas V. A. Boersma
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Alexander H. Maass
- Department of CardiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | | | - Mehran Firouzi
- Department of CardiologyMaasstad HospitalRotterdamThe Netherlands
| | - Cornelis P. Allaart
- Department of CardiologyAmsterdam UMC, VU University, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Kevin Vernooy
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
| | - Robert W. Grauss
- Department of CardiologyHaaglanden Medical CenterThe HagueThe Netherlands
| | - Raymond Tukkie
- Department of CardiologySpaarne GasthuisHaarlemThe Netherlands
| | - Paul Knaapen
- Department of CardiologyAmsterdam UMC, VU University, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Aeilko H. Zwinderman
- Department of Epidemiology and Data ScienceAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
- MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - Marcel G. W. Dijkgraaf
- Department of Epidemiology and Data ScienceAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
- MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - Bimmer E. P. M. Claessen
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Marit van Barreveld
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
- Department of Epidemiology and Data ScienceAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
- MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - Arthur A. M. Wilde
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - José P. S. Henriques
- Department of CardiologyAmsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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Cojocaru C, Nastasa A, Bogdan S, Iorgulescu C, Deaconu A, Onciul S, Vatasescu R. Non-revascularized chronic total occlusions impact on substrate and post-ablation results in drug-refractory electrical storm. Front Cardiovasc Med 2023; 10:1258373. [PMID: 37808884 PMCID: PMC10552148 DOI: 10.3389/fcvm.2023.1258373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background and aims There is limited data concerning the effect of non-revascularized chronic total occlusions (NR-CTOs) after VT ablation. This study sought to evaluate the impact of NR-CTOs after ablation for electrical storm (ES). Methods Post-hoc retrospective analysis of data regarding 64 consecutive post-myocardial infarction patients (out of which 12 patients with NR-CTOs and 52 without NR-CTOs) undergoing substrate ablation for ES with an available median follow-up of 37.53 (7.25-64.65) months. Ablation result was assessed by inducibility of sustained monomorphic VT (SMVT) during final programmed ventricular stimulation (PVS). The primary endpoints were all-cause mortality and VT/VF recurrences after ablation, respectively, stratified by the presence of NR-CTOs. The secondary endpoint was to assess the predictive effect of NR-CTOs on all-cause mortality and VT/VF recurrences in relation to other relevant prognostic factors. Results At baseline, the presence of NR-CTOs was associated with higher bipolar BZ-to-total scar ratio (72.4% ± 17.9% vs. 52% ± 37.7%, p = 0.022) and more failure to eliminate the clinical VT (25% (3) vs. 0% (0), p < 0.001). During follow-up, overall all-cause mortality and recurrences were more frequent in the NR-CTO subgroup (75% (9) vs. 19.2% (10), log rank p = 0.003 and 58.3% vs. 23.1% (12), log rank p = 0.042 respectively). After adjusting for end-procedural residual SMVT inducibility, NR-CTOs predicted death during follow-up (HR 3.380, p = 0.009) however not recurrence (HR 1.986, p = 0.154). Conclusions NR-CTO patients treated by RFCA for drug-refractory ES demonstrated a higher ratio of BZ-to-total-scar area. In this analysis, NR-CTO was associated with worse acute procedural results and may as well impact long-term outcomes which should be further assessed in larger patient populations.
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Affiliation(s)
- Cosmin Cojocaru
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | | | - Stefan Bogdan
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Elias University Hospital, Bucharest, Romania
| | - Corneliu Iorgulescu
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Alexandru Deaconu
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Sebastian Onciul
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Radu Vatasescu
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
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Mid-Term Outcome of Ventricular Arrhythmias Catheter Ablation in Patients with Chronic Coronary Total Occlusion Compared to Ischemic and Non-Ischemic Patients. J Clin Med 2022; 11:jcm11237181. [PMID: 36498755 PMCID: PMC9738135 DOI: 10.3390/jcm11237181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic coronary total occlusions (CTO) are considered an emerging predictor of ventricular arrhythmias (VAs), but currently there are few data on arrhythmic outcomes in patients affected by CTO undergoing radiofrequency catheter ablation of VAs. This study sought to evaluate the impact of unrevascularized CTO on the recurrence of VAs after catheter ablation. This was a single-center retrospective study enrolling 120 patients between 2015 and 2020. All patients were admitted for ventricular tachycardia (VT) or high premature ventricular contractions burden (>25% detected by Holter ECG), without evidence of acute coronary syndrome; they underwent coronary angiography, electrophysiology (EP) study, and three-dimensional electroanatomic mapping (3D-EAM) followed by VAs ablation. Twenty-eight patients (23%) of 120 patients showed CTO at coronary angiography. At baseline, the CTO group presented with higher prevalence of hypertension, chronic renal disease, systolic ventricular dysfunction, secondary prevention ICD implantation, and higher rate of LAVA by 3D-EAM compared with the non-CTO group. At a median follow-up of 15 months (range 1−96 months) after catheter ablation, the only independent predictor of VAs recurrence was the presence of moderate to severe left ventricular (LV) dysfunction. Therefore, the presence of CTO does not predict VAs recurrence after catheter ablation, which is instead predicted by LV dysfunction.
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Relevance of Chronic Total Occlusion for Outcome of Ventricular Tachycardia Ablation in Ischemic Cardiomyopathy. J Interv Cardiol 2022; 2022:6829725. [PMID: 35935125 PMCID: PMC9314168 DOI: 10.1155/2022/6829725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022] Open
Abstract
Background Catheter ablation of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) is an effective tool to prevent VT recurrences. Chronic total occlusion (CTO) represents a clinically relevant entity in ICM patients and is an independent predictor of ventricular arrhythmia and mortality. The effects of CTO on the outcome of VT ablation are not well-studied. Objective This analysis aimed to identify the impact of CTO, revascularized, or not revascularized, on the outcome of VT ablation. Methods and Results Of 385 consecutive subjects with ICM-VT who underwent catheter VT ablation for monomorphic VT at Heart Center Leipzig between 2008 and 2017, 108 patients without CTO and 191 patients with CTO were included in the analysis. Within a median follow-up time of 557 days (IQR 149, 1095), VT recurred in 77 (40%) patients in the CTO and 40 (37.0%) in the non-CTO cohort (p = 0.62). In a multivariable model, a 10% stepwise change in LVEF as well as ICD on admission was associated with VT recurrence (HRadj 1.82, 95% CI 1.04–3.18 and HRadj 1.35, 95% CI 1.23–1.61, respectively). Of the CTO cohort before ablation, 45% had received revascularization, which was independently associated with a higher risk for VT recurrence (HR 2.12, 95% CI 1.35–3.34) as compared to nonrevascularized CTO. Conclusion In ICM patients with and without CTO, VT ablation was associated with equal effectiveness with regard to VT recurrence. However, in revascularized CTO patients, the risk of recurrence of VT after ablation was significantly increased.
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Iannaccone M, Nombela-Franco L, Gallone G, Annone U, Di Marco A, Giannini F, Ayoub M, Sardone A, Amat-Santos I, Fernandez-Lozano I, Barbero U, Dusi V, Toselli M, Petretta A, de Salvia A, Boccuzzi G, Colangelo S, Anguera I, D'Ascenzo F, Colombo A, De Ferrari GM, Escaned J, Garbo R, Mashayekhi K. Impact of successful chronic coronary total occlusion recanalization on recurrence of ventricular arrhythmias in implantable cardioverter-defibrillator recipients for ischemic cardiomyopathy (VACTO PCI study). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:104-111. [DOI: 10.1016/j.carrev.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
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Ahmad Y, Petrie MC, Jolicoeur EM, Madhavan MV, Velazquez EJ, Moses JW, Lansky AJ, Stone GW. PCI in Patients With Heart Failure: Current Evidence, Impact of Complete Revascularization, and Contemporary Techniques to Improve Outcomes. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100020. [PMID: 39132568 PMCID: PMC11307477 DOI: 10.1016/j.jscai.2022.100020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 08/13/2024]
Abstract
Coronary artery disease (CAD) is the most common cause of left ventricular systolic dysfunction (LVSD) and heart failure (HF). Revascularization with coronary artery bypass grafting (CABG) reduces all-cause mortality compared with medical therapy alone for these patients. Despite this, CABG is performed in a minority of patients with HF, partly due to patient unwillingness or inability to undergo major cardiac surgery and partly due to physician reluctance to refer for surgery due to high operative risk. Percutaneous coronary intervention (PCI) is a less-invasive method of revascularization that has the potential to reduce periprocedural complications compared with CABG in patients with HF. Recent advances in PCI technology and technique have made it realistic to achieve more complete revascularization with PCI in high-risk patients with HF, although no randomized controlled clinical trials (RCTs) of PCI in HF compared with either medical therapy or CABG have been performed. In this review, we discuss the currently available evidence for PCI in HF and the association between the extent of revascularization and clinical outcomes in HF. We also review recent advances in PCI technology and techniques with the potential to improve clinical outcomes in HF. Finally, we discuss emerging clinical trial evidence of revascularization in HF and the large, persistent evidence gaps that should be addressed with future clinical trials of revascularization in HF.
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Affiliation(s)
- Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - E. Marc Jolicoeur
- Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Mahesh V. Madhavan
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
- Cardiovascular Research Foundation, New York, New York
| | - Eric J. Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey W. Moses
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
- Cardiovascular Research Foundation, New York, New York
- St Francis Hospital, Roslyn, New York
| | - Alexandra J. Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 558] [Impact Index Per Article: 279.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cao M, Li B, Li Q, Sun C. The Comparison of Long-Term Outcome Between Patients with Single and Multiple Coronary Chronic Total Occlusions After Percutaneous Coronary Intervention. Int J Gen Med 2022; 15:729-736. [PMID: 35082521 PMCID: PMC8786357 DOI: 10.2147/ijgm.s348035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Rapid advancements in percutaneous coronary intervention (PCI) have improved the outcome of chronic coronary total occlusions (CTOs); however, data regarding the difference in long-term outcomes in stable coronary artery disease (CAD) patients with single and multiple CTOs who underwent PCI are scarce. This study aimed to compare the long-term outcomes of patients with multiple CTOs and single CTO after PCI. Methods This study cohort included stable CAD patients who were diagnosed with CTO and treated with PCI from a single center. The primary endpoint was all-cause death. Results We retrospectively reviewed 670 consecutive patients with CTO-PCI. Among them, 539 patients had a single CTO, and 131 (19.7%) patients had multiple (at least two) CTOs. CTO revascularization was achieved in 470 (70.1%) patients. After a median follow-up duration of 33.7 months, the cumulative all-cause mortality (p = 0.037) and cardiac mortality (p = 0.003) were higher in patients with multiple CTOs than in those with a single CTO. In the multivariable model, multiple CTOs and left ventricular ejection fraction (LVEF) less than 40% were independent predictors for cardiac death (adjusted hazard ratio (HR) 2.53; P = 0.013 and adjusted HR 3.95; P < 0.001), while age older than 65 and LVEF less than 40% were independent predictors for all-cause death in CTO-PCI patients (adjusted hazard ratio (HR) 1.84; P = 0.035 and adjusted HR 2.54; P = 0.001). Conclusion In CTO-PCI patients, long-term survival was associated with multiple CTOs, age and LVEF, but not with CTO revascularization.
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Affiliation(s)
- Miaomiao Cao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Bolin Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Qian Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
- Correspondence: Chaofeng Sun, Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an, 710061, People’s Republic of China, Email
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Patel U, Zubair M, Munshi R, Desai R, Makaryus AN. Trends and outcomes of chronic coronary total occlusion-related ventricular tachyarrhythmias. Proc AMIA Symp 2021; 34:541-544. [PMID: 34456469 DOI: 10.1080/08998280.2021.1913039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Our study aims to establish trends and frequencies of ventricular tachyarrhythmia (VTA) among patients with chronic coronary total occlusion (CCTO). We identified CCTO hospitalizations with and without VTA using the National Inpatient Sample. A total of 911,579 CCTO-related hospitalizations were identified, with 92,450 (10.1%) encounters associated with VTA. The CCTO-VTA cohort showed higher all-cause mortality (adjusted odds ratio [aOR] = 4.45, P < 0.001), longer hospital stays (6.8 vs 4.6 days; P < 0.001), and higher hospital charges ($117,382 vs $75,419; P < 0.001) compared to the CCTO non-VTA group. Rates and odds of cardiogenic shock (aOR = 4.19), venous thromboembolism (aOR = 2.09), respiratory failure (aOR = 2.85), and requirement of mechanical ventilation (aOR = 4.23) were higher in the CCTO-VTA group (P < 0.001). Over time, there was an increase in VTA (9.2% in 2010 to 12.1% in 2014) and all-cause mortality (7.5% in 2010 to 12.4% in 2014; P < 0.001). Trends in VTA among patients with CCTO increased by 4.8% for undergoing percutaneous coronary intervention and by 2.5% for undergoing both percutaneous coronary intervention and coronary artery bypass grafting (P < 0.001). Occurrence of VTA among CCTO patients is associated with worse outcomes and higher resource utilization.
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Affiliation(s)
- Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Mohammed Zubair
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Rezwan Munshi
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, New York.,Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York
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Eertmans W, Hendrickx I, Pauwels R, Maeremans J, McCutcheon K, Kayaert P, Bataille Y, Bennett J, Dens J. Revascularisation of chronic total occlusions and recurrence rate of ventricular arrhythmias. Acta Cardiol 2021; 76:353-358. [PMID: 32138629 DOI: 10.1080/00015385.2020.1736762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The impact of revascularisation of chronic total occlusions (CTO) on the incidence of ventricular arrhythmias (VA) remains to be elucidated. METHODS Based on prospectively gathered data, the recurrence rate of VAs following CTO treatment was retrospectively investigated. Patients presenting with VAs as clinical indication for CTO revascularisation were retrospectively selected out of three Belgian CTO registries (i.e. Ziekenhuis Oost-Limburg, UZ Leuven and CHR de la Citadelle). Freedom of VAs was defined as absence of non-sustained or sustained tachycardias (VT), ventricular fibrillations (Vfib) and ventricular extrasystoles (VES; <2500 VES/24 h). Long-term outcome in terms of reoccurrence of VAs was evaluated by reviewing patient records. RESULTS Between 2011 and 2019, 912 patients underwent a CTO-PCI across three Belgian centres. In total 43 patients (5%) presented with VAs as clinical indication for CTO revascularisation. Overall follow-up was 723 (391 - 1144) days. Fourteen (33%), 18 (42%), 5 (11%) and 6 (14%) presented with >2500 VES/24 hrs, non-sustained VT, sustained VT and Vfib, respectively. In those patients with a one-year follow-up available (n = 34), overall recurrence rate of VAs was 38% (within VA group: VES: 25%, non-sustained VT: 46%; sustained VT: 25% and Vfib: 60%). CONCLUSION Based on this retrospective data analysis, CTO revascularisation, in patients presenting with VAs as the main clinical indication, seems to beneficially impact the incidence of VAs, which ultimately might result in improved patients' outcome.
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Affiliation(s)
- Ward Eertmans
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ief Hendrickx
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ruben Pauwels
- Department of Cardiovascular Medicine, Katholieke Universiteit, Leuven, Belgium
| | - Joren Maeremans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, Katholieke Universiteit, Leuven, Belgium
| | | | - Yoann Bataille
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, Katholieke Universiteit, Leuven, Belgium
| | - Jo Dens
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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van der Graaf M, Jewbali LSD, Lemkes JS, Spoormans EM, van der Ent M, Meuwissen M, Blans MJ, van der Harst P, Henriques JP, Beishuizen A, Camaro C, Bleeker GB, van Royen N, Yap SC. Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors. Neth Heart J 2021; 29:500-505. [PMID: 34046780 PMCID: PMC8455757 DOI: 10.1007/s12471-021-01578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event. Supplementary Information The online version of this article (10.1007/s12471-021-01578-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M van der Graaf
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L S D Jewbali
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J S Lemkes
- Department of Cardiology, Amsterdam University Medical Centre VUMC, Amsterdam, The Netherlands
| | - E M Spoormans
- Department of Cardiology, Amsterdam University Medical Centre VUMC, Amsterdam, The Netherlands
| | - M van der Ent
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - M J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - P van der Harst
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J P Henriques
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - C Camaro
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G B Bleeker
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S C Yap
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Prognostic impact of coronary chronic total occlusion on recurrences of ventricular tachyarrhythmias and ICD therapies. Clin Res Cardiol 2020; 110:281-291. [PMID: 33150467 DOI: 10.1007/s00392-020-01758-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite a few studies evaluating the prognostic impact of coronary chronic total occlusion (CTO) in implantable cardioverter defibrillator (ICD) recipients, the impact of CTO on different types of recurrences of ventricular tachyarrhythmias, as well as their predictors has not yet been investigated in CTO patients. METHODS A large retrospective registry was used including all consecutive patients with ventricular tachyarrhythmias undergoing coronary angiography at index from 2002 to 2016. Only ICD recipients with CTO were compared to patients without (non-CTO). Kaplan-Meier and Cox regression analyses were applied for the primary end point of first recurrence of ventricular tachyarrhythmias at 5 years. Secondary end points comprised of the different types of recurrences, first appropriate ICD therapy and all-cause mortality at 5 years. RESULTS From a total of 422 consecutive ICD recipients with ventricular tachyarrhythmias at index, at least one CTO was present in 25%. CTO was associated with the primary end point of first recurrence of ventricular tachyarrhythmias at 5 years (55% vs. 39%; log rank p = 0.001; HR = 1.665; 95% CI 1.221-2.271; p = 0.001), as well as increased risk of first appropriate ICD therapy (40% vs. 31%; log rank p = 0.039; HR = 1.454; 95% CI 1.016-2.079; p = 0.041) and all-cause mortality at 5 years (26% vs. 16%; log rank p = 0.011; HR = 1.797; 95% CI 1.133-2.850; p = 0.013). Less developed collaterals (i.e., either ipsi- or contralateral compared to bilateral) and a J-CTO score ≥ 3 were strongest predictors of recurrences in CTO patients at 5 years. CONCLUSION A coronary CTO even in the presence of less developed collaterals and more complex CTO category is associated with increasing risk of recurrent ventricular tachyarrhythmias at 5 years in consecutive ICD recipients.
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Shokry KAA, Farag ESM, Salem AMH, Abdelaziz M, El-Zayat A, Ibrahim IM. Relationship between quality of coronary collateral and myocardial viability in chronic total occlusion: a magnetic resonance study. Int J Cardiovasc Imaging 2020; 37:623-631. [PMID: 32940819 DOI: 10.1007/s10554-020-02027-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
Revascularization of chronic total occlusion (CTO) is still debated regarding its indications and therapeutic benefits. Guidelines recommend patient selection based on ischemia detection and viability assessment. We aimed to investigate the relationship between the quality of coronary collaterals (CC), graded by Rentrop classification, and myocardial viability assessed by cardiovascular magnetic resonance (CMR). Unselected 100 consecutive patients with a single CTO were prospectively enrolled. CC of Rentrop grade two or three were considered as well-developed. Analyzing late gadolinium enhancement (LGE) images, CTO territories with mean segmental transmural scar extent < 50% were considered viable. Of the 100 patients (70 male, mean age 58.0 ± 6 years), 73 patients (73%) had angiographically visible CC. Based on LGE, patients were classified into viable (n = 50) and non-viable (n = 50) groups. Significant differences between both groups existed regarding frequency of diabetes mellitus (p = 0.044), frequency of congestive heart failure (p = 0.032), presence of pathological Q in CTO territory (p = 0.039); and presence of well-developed CC (p < 0.001). Binary logistic regression and receiver operating characteristic curve showed that presence of well-developed CC could independently (OR 9.4, 95% CI: 2.6-33.6, p < 0.001) predict myocardial viability with a sensitivity and a specificity of 72% and 74%, respectively (AUC: 0.796, 95% CI: 0.708-0.884, P < 0.001). The presence of well-developed CC could independently predict with high accuracy myocardial viability assessed by LGE in territories subtended by CTO vessels. Therefore, search for viable myocardium using different imaging modalities, e.g. CMR, may be recommended in CTO patients with well-developed CC.
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Affiliation(s)
| | | | | | - Mahmoud Abdelaziz
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed El-Zayat
- Department of Cardiology, Zagazig University, Zagazig, Egypt
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Assaf A, Diletti R, Hoogendijk MG, van der Graaf M, Zijlstra F, Szili-Torok T, Yap SC. Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion. Expert Rev Cardiovasc Ther 2020; 18:487-494. [PMID: 32684000 DOI: 10.1080/14779072.2020.1793671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The presence of a chronic total occlusion (CTO) is associated with an increased risk of ventricular arrhythmias. AREAS COVERED This review provides an overview of the relationship between CTO and ventricular arrhythmias, arrhythmogenic mechanisms, and the effect of revascularization. EXPERT OPINION Studies in recipients of an implantable cardioverter-defibrillator (ICD) have shown that a CTO is an independent predictor of appropriate ICD therapy. The myocardial territory supplied by a CTO is a pro-arrhythmogenic milieu characterized by scar tissue, large scar border zone, hibernating myocardium, residual ischemia despite collaterals, areas of slow conduction, and heterogeneity in repolarization. Restoring coronary flow by revascularization might be associated with electrical homogenization as reflected by a decrease in QT(c) dispersion, decrease in T wave peak-to-end interval, reduction of late potentials, and decrease in scar border zone area. Future research should explore whether CTO revascularization results in a lower burden of ventricular arrhythmias. Furthermore, risk stratification of CTO patients without severe LV dysfunction is interesting to identify potential ICD candidates. Potential tools for risk stratification are the use of electrocardiographic parameters, body surface mapping, electrophysiological study, and close rhythm monitoring using an insertable cardiac monitor.
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Affiliation(s)
- Amira Assaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
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Behnes M, Akin I, Kuche P, Schupp T, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, El-Battrawy I, Lang S, Brilakis ES, Azzalini L, Galassi AR, Boukhris M, Neuser H, Neumann FJ, Nienaber C, Weiß C, Borggrefe M, Mashayekhi K. Coronary chronic total occlusions and mortality in patients with ventricular tachyarrhythmias. EUROINTERVENTION 2020; 15:1278-1285. [DOI: 10.4244/eij-d-18-00496] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Vutthikraivit W, Rattanawong P, Kewcharoen J, Kanitsoraphan C, Pachariyanon P, Suchartlikitwong S, Klomjit S, Tantrachoti P. Impact of chronic total occlusion on ventricular arrhythmia and mortality in ischaemic cardiomyopathy patient with implantable cardiac defibrillator: a meta-analysis. Acta Cardiol 2019; 74:395-402. [PMID: 30328769 DOI: 10.1080/00015385.2018.1516268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Recent studies suggested that chronic total occlusion of the coronary artery increased risk of ventricular arrhythmia (VA) and all-cause mortality in ischaemic cardiomyopathy (ICM) patient who underwent implantable cardiac defibrillator (ICD) implantation. We aim to demonstrate an association between a presence of CTO and poor cardiovascular outcome in ICD implanted ICM patients. Objective: To examine the association between the presence of CTO and all-cause mortality in ICM with ICD implantation Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to February 2018. The studies that reported appropriated shock and all-cause mortality in ICD implanted ICM patients, compared between patients with and without CTO of the coronary artery, were included for meta-analysis. Results: Five studies from 2015 to 2018 were included in this meta-analysis involving 1,095 subjects (505 CTO and 590 non-CTO). The presence of CTO was associated with increased incidence of VA (pooled risk ratio = 1.75, 95% confidence interval: 1.10-2.77, p = 0.01) and all-cause mortality (pooled risk ratio = 1.63, 95% confidence interval: 1.10-2.41, p = 0.001) in ICD implanted ICM patients. Conclusions: Presence of CTO of the coronary artery increased risk of VA and all-cause mortality in ICD implanted ICM patients up to 75% and 63%, respectively. Our study suggested that CTO is an independent predictor of unfavourable outcome and revascularised option should be considered in ICM patients with ICD.
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Affiliation(s)
- Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Pavida Pachariyanon
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Saranapoom Klomjit
- Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pakpoom Tantrachoti
- Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Allahwala UK, Ward MR, Brieger D, Weaver JC, Bhindi R. Indications for Percutaneous Coronary Intervention (PCI) in Chronic Total Occlusion (CTO): Have We Reached a DECISION or Do We Continue to EXPLORE After EURO-CTO? Heart Lung Circ 2019; 28:1484-1489. [DOI: 10.1016/j.hlc.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/06/2019] [Accepted: 03/19/2019] [Indexed: 01/09/2023]
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Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:127. [PMID: 30815422 PMCID: PMC6387802 DOI: 10.14196/mjiri.32.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
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Godino C, Giannattasio A, Scotti A, Baldetti L, Pivato CA, Munafò A, Cappelletti A, Beneduce A, Melillo F, Chiarito M, Biondi Zoccai G, Frati G, Fragasso G, Azzalini L, Carlino M, Montorfano M, Margonato A, Colombo A. Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion. Heart 2019; 105:1096-1102. [PMID: 30792237 DOI: 10.1136/heartjnl-2018-314076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
ObjectiveThe aim of this study is to evaluate the long-term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI).MethodsFrom a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs.ResultsUp to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients.ConclusionsAt long-term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events .
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Giannattasio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Baldetti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Chiarito
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Milan, Italy
| | - Giuseppe Biondi Zoccai
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gabriele Fragasso
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and Mortality Outcomes: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2018; 4:1214-1223. [PMID: 30236396 DOI: 10.1016/j.jacep.2018.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) status and the occurrence of ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate implantable cardioverter-defibrillator (ICD) therapy. BACKGROUND CTO is a significant problem in patients with ischemic heart disease. However, the extent to which it predisposes affected individuals to VT/VF and whether these arrhythmic events could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO status and the occurrence of VT/VF or appropriate ICD therapy. METHODS PubMed and Embase databases were searched until November 16, 2017, identifying 137 studies. RESULTS Seventeen studies involving 54,594 subjects (mean age, 61 ± 21 years of age, 81% male) with a mean follow-up of 43 ± 31 months were included. The presence of CTO was associated with higher risk of VT/VF or appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to 2.59; p < 0.0001, I2 = 3%) but not in cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18, I2 = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14; I2 = 64%). Compared to patients with non-infarct-related CTOs, those with infarct-related CTOs have a higher risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I2 = 14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05; I2 = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I2 = 40%). Nonrevascularization of CTOs tended to be associated with an increased risk of all-cause mortality compared to successful revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08; I2 = 76). CONCLUSIONS CTOs, especially infarct-related, are associated with high risk of VT/VF or appropriate ICD therapy and mortality. ICD implantation could be beneficial. However, it is not clear that revascularization has an impact on the outcome of patients with CTOs.
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Wang ZQ, Qiang H, Luo X, Li W, Guo K, Li YG. Meta-Analysis of Risk of Ventricular Arrhythmias and All-Cause Mortality in Patients With Chronic Total Occlusion of a Coronary Artery and/or Implantable Cardioverter-Defibrillator. Am J Cardiol 2018; 121:1149-1154. [PMID: 29548677 DOI: 10.1016/j.amjcard.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/25/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
Implantable cardioverter-defibrillator (ICD) has been increasingly used to prevent sudden death in patients with high risk of ventricular arrhythmias (VAs). Chronic total occlusion (CTO) is a severe condition of coronary artery disease. However, the prognostic impact of CTO in ICD recipients remains controversial. We systematically searched the PubMed, EMBASE, and Cochrane databases for documents published before October 1, 2017 to identify studies that investigated the prognostic impact of CTO on VAs and all-cause mortality (ACM) in ICD recipients. The effect size was expressed by hazard ratio (HR) and 95% confidence interval (CI). Overall, 6 studies with 1,423 patients were included. We found that CTO independently predicted the occurrence of VAs in the global population (HR 1.77, 95% CI 1.14 to 2.76, p = 0.01). Subgroup analysis revealed that CTO only predicted VAs in patients receiving ICD as secondary prevention (HR 1.96, 95% CI 1.55 to 2.48, p <0.01). However, CTO was not associated with ACM in the global population (HR 1.51, 95% CI 0.99 to 2.32, p = 0.06). Further subgroup analysis still showed no association between CTO and ACM in patients receiving ICD as primary prevention (HR 1.49, 95% CI 0.43 to 5.21, p = 0.53) or secondary prevention (HR 1.56, 95% CI 0.87 to 2.78, p = 0.13). In conclusion, CTO is an independent predictor of VAs in patients with secondary-prevention ICD, but not for ACM. Our study provided additional evidence for improving the risk stratification and management of VAs in ICD recipients.
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van Dongen IM, Yilmaz D, Elias J, Claessen BEPM, Delewi R, Knops RE, Wilde AAM, van Erven L, Schalij MJ, Henriques JPS. Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long-Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter-Defibrillator (the eCTOpy-in-ICD Study). J Am Heart Assoc 2018; 7:JAHA.118.008609. [PMID: 29720502 PMCID: PMC6015331 DOI: 10.1161/jaha.118.008609] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Previous studies report conflicting results about a higher incidence of ventricular arrhythmias in patients with a chronic total coronary occlusion (CTO). We aimed to investigate this association in a large cohort of implantable cardioverter defibrillator patients with long‐term follow‐up. Methods and Results All consecutive patients from 1992 onwards who underwent implantable cardioverter defibrillator implantation for ischemic cardiomyopathy at the Leiden University Medical Center were evaluated. Coronary angiograms were reviewed for the presence of a CTO. The occurrence of ventricular arrhythmias and survival status at follow‐up were compared between patients with and patients without a CTO. A total of 722 patients constitute the study cohort (age 66±11 years; 84% males; 74% primary prevention, median left ventricular ejection fraction 30% [first–third quartile: 25–37], 44% received a cardiac resynchronization therapy defibrillator). At baseline, 240 patients (33%) had a CTO, and the CTOs were present for at least 44 (2–127) months. The median follow‐up duration was 4 (2–6) years. On long‐term follow‐up, CTO patients had a higher crude appropriate device therapy rate (37% versus 27%, P=0.010) and a lower crude survival rate (51% versus 67%, P<0.001) compared with patients without a CTO. Corrected for baseline characteristics including left ventricular ejection fraction, the presence of a CTO was an independent predictor for appropriate device therapy. Conclusions The presence of a CTO in implantable cardioverter defibrillator patients was associated with more appropriate device therapy and worse prognosis at long‐term follow‐up. Further investigation is warranted regarding a potential beneficial effect of CTO revascularization on the incidence of ventricular arrhythmias.
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Affiliation(s)
- Ivo M van Dongen
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Dilek Yilmaz
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joëlle Elias
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
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25
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Marechal P, Davin L, Gach O, Martinez C, Lempereur M, Lhoest N, Lancellotti P. Coronary chronic total occlusion intervention: utility or futility. Expert Rev Cardiovasc Ther 2018; 16:361-367. [PMID: 29589974 DOI: 10.1080/14779072.2018.1459187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Despite an incidence of about 18-52% of the patients undergoing coronary angiography, chronic total occlusions (CTO) are rarely revascularised by percutaneous angioplasty (PCI). Nevertheless, current evidence suggests that successful CTO angioplasty improves symptoms, quality of life and long-term survival. During the last decade, the improvement of specific tools and techniques for these complex procedures, and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO angioplasty. Areas covered: This review focuses on the clinical benefits of CTO revascularization and on appropriate patient selection. Expert commentary: Current evidence suggests that successful CTO-PCI improves symptoms, quality of life and long-term survival. During the last years, the improvement of specific techniques for these complex procedures and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO lesion angioplasty.
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Affiliation(s)
- Patrick Marechal
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Laurent Davin
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Olivier Gach
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Christophe Martinez
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Mathieu Lempereur
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | | | - Patrizio Lancellotti
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium.,c Gruppo Villa Maria Care and Research , Anthea Hospital , Bari , Italy
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Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Department of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX
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Yap SC, Sakhi R, Theuns DA, Yasar YE, Bhagwandien RE, Diletti R, Zijlstra F, Szili-Torok T. Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion. Heart Rhythm 2018; 15:124-129. [DOI: 10.1016/j.hrthm.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Indexed: 12/20/2022]
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28
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Bergau L, Tichelbäcker T, Kessel B, Lüthje L, Fischer TH, Friede T, Zabel M. Predictors of mortality and ICD shock therapy in primary prophylactic ICD patients-A systematic review and meta-analysis. PLoS One 2017; 12:e0186387. [PMID: 29040341 PMCID: PMC5645142 DOI: 10.1371/journal.pone.0186387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/30/2017] [Indexed: 01/21/2023] Open
Abstract
Background There is evidence that the benefit of a primary prophylactic ICD therapy is not equal in all patients. Purpose To evaluate risk factors of appropriate shocks and all- cause mortality in patients with a primary prophylactic ICD regarding contemporary studies. Data source PubMed, LIVIVO, Cochrane CENTRAL between 2010 and 2016. Study selection Studies were eligible if at least one of the endpoints of interest were reported. Data extraction All abstracts were independently reviewed by at least two authors. The full text of all selected studies was then analysed in detail. Data synthesis Our search strategy retrieved 608 abstracts. After exclusion of unsuitable studies, 36 papers with a total patient number of 47282 were included in our analysis. All-cause mortality was significantly associated with increasing age (HR 1.41, CI 1.29–1.53), left ventricular function (LVEF; HR 1.21, CI 1.14–1.29), ischemic cardiomyopathy (ICM; HR 1.37, CI 1.14–1.66) and co-morbidities such as impaired renal function (HR 2.30, CI 1.97–2.69). Although, younger age (HR 0.96, CI 0.85–1.09), impaired LVEF (HR 1.26, CI 0.89–1.78) and ischemic cardiomyopathy (HR 2.22, CI 0.83–5.93) were associated with a higher risk of appropriate shocks, none of these factors reached statistical significance. Limitations Individual patient data were not available for most studies. Conclusion In this meta-analysis of contemporary clinical studies, all-cause mortality is predicted by a variety of clinical characteristics including LVEF. On the other hand, the risk of appropriate shocks might be associated with impaired LVEF and ischemic cardiomyopathy. Further prospective studies are required to verify risk factors for appropriate shocks other than LVEF to help select appropriate patients for primary prophylactic ICD-therapy.
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MESH Headings
- Age Factors
- Aged
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Humans
- Male
- Middle Aged
- Myocardial Ischemia/complications
- Myocardial Ischemia/diagnosis
- Myocardial Ischemia/mortality
- Myocardial Ischemia/therapy
- Primary Prevention
- Prognosis
- Prospective Studies
- Risk Factors
- Survival Analysis
- Ventricular Function, Left
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Affiliation(s)
- Leonard Bergau
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Tichelbäcker
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Barbora Kessel
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Lars Lüthje
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas H. Fischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
- * E-mail:
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29
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Di Marco A, Anguera I, Teruel L, Muntane G, Campbell NG, Fox DJ, Brown B, Skene C, Davidson N, Leon V, Dallaglio P, Elzein H, Garcia-Romero E, Gomez-Hospital JA, Cequier A. Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies. J Cardiovasc Electrophysiol 2017; 28:1169-1178. [DOI: 10.1111/jce.13290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/08/2017] [Accepted: 05/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Di Marco
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Ignasi Anguera
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Luis Teruel
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Guillem Muntane
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Niall G. Campbell
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - David J. Fox
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Benjamin Brown
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Chris Skene
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Neil Davidson
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Valentina Leon
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Paolo Dallaglio
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Hind Elzein
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | | | | | - Angel Cequier
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
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30
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Nishikawa T, Fujino M, Nakajima I, Asaumi Y, Kataoka Y, Anzai T, Kusano K, Noguchi T, Goto Y, Nishimura K, Miyamoto Y, Kiso K, Yasuda S. Prognostic impact of chronic total coronary occlusion on long-term outcomes in implantable cardioverter-defibrillator recipients with ischaemic heart disease. Europace 2017; 19:1153-1162. [PMID: 27738062 DOI: 10.1093/europace/euw213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/20/2016] [Indexed: 11/15/2022] Open
Abstract
Aims The prognostic impact of chronic total coronary occlusion (CTO) on implantable cardioverter-defibrillator (ICD) recipients remains unclear. Methods and results Eighty-four consecutive patients with ischaemic heart disease who received ICD therapy for primary or secondary prevention were analysed. We investigated all-cause mortality and major adverse cardiac events (MACEs) including cardiac death, appropriate device therapy, hospitalization for heart failure, and ventricular assist device implantation. Of the study patients (mean age 70 ± 8 years; 86% men), 34 (40%) had CTO. There were no significant differences in age, left ventricular ejection fraction (LVEF), New York Heart Association functional class III or IV status, and proportion who underwent secondary prevention between patients with CTO (CTO group) and without CTO (non-CTO group). During a median follow-up of 3.8 years (interquartile range 2.7-5.4 years), the CTO group tended to have a higher MACE rate (log-rank P = 0.054) than the non-CTO group. Within the CTO group, there was no difference in the MACE rate between patients with and without viable myocardium. In patients with ICD for secondary prevention (n = 47), 16 patients (34%) with CTO had a higher MACE rate than patients without CTO (log-rank P < 0.01). Cox proportional hazards regression analysis showed that the presence of CTO, but not LVEF, was associated with a higher MACE rate. Multivariate analysis showed that the presence of CTO was a predictor of MACE (P < 0.05). Conclusion In patients with ischaemic heart disease receiving ICD implantation, the presence of CTO has an adverse impact on long-term prognosis, especially as secondary prevention.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/prevention & control
- Chi-Square Distribution
- Chronic Disease
- Coronary Occlusion/complications
- Coronary Occlusion/mortality
- Coronary Occlusion/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/adverse effects
- Electric Countershock/instrumentation
- Electric Countershock/mortality
- Female
- Heart Failure/etiology
- Heart Failure/therapy
- Heart-Assist Devices
- Hospitalization
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Multivariate Analysis
- Primary Prevention/instrumentation
- Proportional Hazards Models
- Retrospective Studies
- Risk Factors
- Secondary Prevention/instrumentation
- Stroke Volume
- Time Factors
- Treatment Outcome
- Ventricular Function, Left
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Affiliation(s)
- Tatsuya Nishikawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
- Department of Pathophysiology Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ikutaro Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Keisuke Kiso
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Nombela-Franco L, Iannaccone M, Anguera I, Amat-Santos IJ, Sanchez-Garcia M, Bautista D, Calvelo MN, Di Marco A, Moretti C, Pozzi R, Scaglione M, Cañadas V, Sandin-Fuentes M, Arenal A, Bagur R, Perez-Castellano N, Fernandez-Perez C, Gaita F, Macaya C, Escaned J, Fernández-Lozano I. Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study). JACC Cardiovasc Interv 2017; 10:879-888. [DOI: 10.1016/j.jcin.2017.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/30/2017] [Accepted: 02/09/2017] [Indexed: 01/14/2023]
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32
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Di Marco A, Anguera I, Teruel L, Dallaglio P, González-Costello J, León V, Nuñez E, Manito N, Gómez-Hospital JA, Sabaté X, Cequier Á. Chronic total occlusion of an infarct-related artery: a new predictor of ventricular arrhythmias in primary prevention implantable cardioverter defibrillator patients. Europace 2016; 19:267-274. [DOI: 10.1093/europace/euw009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/06/2016] [Indexed: 01/09/2023] Open
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33
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Nombela-Franco L, Ryan N. Ischemic Cardiomyopathy and Chronic Total Occlusions. JACC Cardiovasc Interv 2016; 9:1798-800. [DOI: 10.1016/j.jcin.2016.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 12/12/2022]
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34
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Brilakis ES, Karmpaliotis D, Vo MN, Carlino M, Galassi AR, Boukhris M, Alaswad K, Bryniarski L, Lombardi WL, Banerjee S. Update on Coronary Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2016; 5:177-186. [PMID: 28582202 DOI: 10.1016/j.iccl.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved during recent years. High success rates are being achieved by experienced centers and operators, but not at less-experienced centers. Use of CTO crossing algorithms can help improve the success and efficiency of these potentially lengthy procedures. There is a paucity of clinical trial data examining clinical outcomes of CTO PCI, which is critical for further adoption and refinement of the procedure. We provide a detailed overview of the clinical evidence and current available crossing strategies, with emphasis on recent developments and techniques.
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Affiliation(s)
- Emmanouil S Brilakis
- Department of Cardiovascular Diseases, VA North Texas Healthcare System, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
| | - Dimitri Karmpaliotis
- Department of Cardiovascular Diseases, NYP Columbia University, New York, NY, USA
| | - Minh N Vo
- St Boniface Hospital Cardiac Science Program, University of Manitoba, Winnipeg, Canada
| | - Mauro Carlino
- Department of Cardiovascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Alfredo R Galassi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Department of Cardiovascular Diseases, University of Zurich, Zurich, Switzerland
| | - Marouane Boukhris
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Khaldoon Alaswad
- Department of Cardiovascular Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Leszek Bryniarski
- Department of Cardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Subhash Banerjee
- Department of Cardiovascular Diseases, VA North Texas Healthcare System, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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