1
|
Katsillis N, Kariki O, Gavrielatos G, Dimopoulos A, Papakonstantinou N, Bousoula E, Linardakis S, Saplaouras A, Malakos J, Dragasis S, Letsas KP, Efremidis M, Patsourakos N. Ventricular arrhythmias in patients with chronic total occlusion of coronary arteries: a review focused on interventional treatments. Hellenic J Cardiol 2025:S1109-9666(25)00126-5. [PMID: 40348335 DOI: 10.1016/j.hjc.2025.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/08/2025] [Accepted: 04/10/2025] [Indexed: 05/14/2025] Open
Abstract
A chronic total occlusion (CTO) of a coronary artery is present in almost one-fifth of patients undergoing a scheduled coronary angiography. A CTO may be classified as infarct related when there is evidence of myocardial dysfunction in the territory of the obstructed vessel or as non-infarct related when the myocardial substrate has preserved its systolic function. The presence of a CTO has been associated with an increased risk of malignant ventricular arrhythmias (VAs), appropriate ICD shocks, and cardiac mortality, with infarct-related CTOs exhibiting a worse prognosis. During the last decade, technological advancements have improved the success rates of transcatheter revascularization, a treatment that has been proven valuable for persistently symptomatic patients. However, the role of revascularization in reducing the arrhythmic burden is unclear. On the contrary, catheter ablation of VAs has been suggested to be effective, despite the presence of a CTO. As for device therapies, an increased prevalence of appropriate ICD shocks should be expected in this population, bringing into consideration the implementation of the presence of CTO as a risk modifier in sudden cardiac death prevention algorithms. The aim of this review is to present the existing literature on the role of all kinds of interventions in the management of patients with CTOs and VAs.
Collapse
Affiliation(s)
- Nikitas Katsillis
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece.
| | - Ourania Kariki
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Antonios Dimopoulos
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| | | | - Elena Bousoula
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| | - Sarantos Linardakis
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| | | | - John Malakos
- Interventional Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | - Nikolaos Patsourakos
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- Ankit Kumar Sahu
- From the Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Assaf A, Sakhi R, Diletti R, Hirsch A, Allaart CP, Bhagwandien R, Firouzi M, Smits PC, Hoogendijk MG, Theuns DA, Yap SC. Incidence of ventricular arrhythmias in patients with chronic total coronary occlusion: Results of the VACTOR study. IJC HEART & VASCULATURE 2024; 50:101323. [PMID: 38188347 PMCID: PMC10768522 DOI: 10.1016/j.ijcha.2023.101323] [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: 10/05/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 01/09/2024]
Abstract
Background A chronic total coronary occlusion (CTO) is associated with ventricular arrhythmias (VA) in patients with an implantable cardioverter-defibrillator (ICD). Limited data is available on the incidence of VA in CTO patients without an ICD. Objectives To investigate the incidence of sustained VA in CTO patients after successful CTO revascularization and in patients with untreated CTO or failed CTO revascularization. Methods Prospective, multicenter observational pilot study including CTO patients who were not eligible for an ICD and had a left ventricular ejection fraction >35 %. We enrolled patients with a successful CTO revascularization (group A) and patients with untreated CTO or failed CTO revascularization (group B). All patients received an implantable loop recorder with remote monitoring. The primary endpoint was sustained VA. Results Ninety patients were enrolled (mean age 63 ± 10 years, 83.3 % man, mean LVEF 55 ± 8 %). Group A (n = 45) had a higher prevalence of CTO in the left anterior descending artery in comparison to group B (n = 45) (28.9 % versus 4.4 %, P = 0.002). Other baseline characteristics were similar. During a median follow-up time of 26 months (IQR, 19-35), five patients (5.6 %) had a sustained VA. There was no difference in the incidence of sustained VA between groups (3-year cumulative event rate: 8.8 % (group A) versus 4.5 % (Group B), log-rank P = 0.71). Conclusion Patients with an CTO, who do not qualify for an ICD, have a substantial risk of sustained VA. In our study the incidence was not different between patients with revascularized and those with untreated CTO.
Collapse
Affiliation(s)
- Amira Assaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rafi Sakhi
- 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
| | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rohit Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mehran Firouzi
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Pieter C. Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Mark G. Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dominic A.M.J. Theuns
- 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
| |
Collapse
|
5
|
Assaf A, van der Graaf M, van Boven N, van Ettinger MJB, Diletti R, Hoogendijk MG, Szili-Torok T, Theuns DAMJ, Yap SC. Effect of myocardial scar size on the risk of ventricular arrhythmias in patients with chronic total coronary occlusion. Int J Cardiol 2023; 390:131205. [PMID: 37482094 DOI: 10.1016/j.ijcard.2023.131205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The presence of an untreated chronic total coronary occlusion (CTO) is associated with a higher risk of ventricular arrhythmias (VAs). This increased risk may be modulated by the presence of an existing scar. OBJECTIVES To evaluate whether scar size is associated with VA in patients with an implantable cardioverter-defibrillator (ICD) and a CTO. METHODS In this retrospective study we included patients with a CTO that received an ICD between 2005 and 2015. Scar size was estimated using the Selvester QRS score on a baseline 12‑lead ECG. The primary endpoint was any appropriate ICD therapy. RESULTS Our study population comprised 148 CTO patients with a median scar size at baseline of 18% (IQR, 9-27%). Patients with a scar size ≥18% more often had a CTO located in the left anterior descending artery and a higher proportion of poor left ventricular function (<35%) and infarct-related CTO compared to patients with a smaller scar size (<18%). During a median follow-up of 35 months (interquartile range [IQR], 8-60 months), 42 patients (28%) received appropriate ICD therapy. The cumulative 5-year event rate was higher in the patients with a large scar in comparison to those with a smaller or no scar (36% versus 19%, P = 0.04). Multivariable Cox regression analysis demonstrated that large scar and diabetes mellitus were independent factors associated with appropriate ICD therapy. CONCLUSION In ICD recipients with an untreated CTO, a larger scar is an independent factor associated with an increased risk of VA.
Collapse
Affiliation(s)
- Amira Assaf
- 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
| | - Nick van Boven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J B van Ettinger
- 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
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dominic A M J Theuns
- 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.
| |
Collapse
|
6
|
Liao R, Li Z, Wang Q, Lin H, Sun H. Revascularization of chronic total occlusion coronary artery and cardiac regeneration. Front Cardiovasc Med 2022; 9:940808. [PMID: 36093131 PMCID: PMC9455703 DOI: 10.3389/fcvm.2022.940808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary chronic total occlusion (CTO) contributes to the progression of heart failure in patients with ischemic cardiomyopathy. Randomized controlled trials demonstrated that percutaneous coronary intervention (PCI) for CTO significantly improves angina symptoms and quality of life but fails to reduce clinical events compared with optimal medical therapy. Even so, intervening physicians strongly support CTO-PCI. Cardiac regeneration therapy after CTO-PCI should be a promising approach to improving the prognosis of ischemic cardiomyopathy. However, the relationship between CTO revascularization and cardiac regeneration has rarely been studied, and experimental studies on cardiac regeneration usually employ rodent models with permanent ligation of the coronary artery rather than reopening of the occlusive artery. Limited early-stage clinical trials demonstrated that cell therapy for cardiac regeneration in ischemic cardiomyopathy reduces scar size, reverses cardiac remodeling, and promotes angiogenesis. This review focuses on the status quo of CTO-PCI in ischemic cardiomyopathy and the clinical prospect of cardiac regeneration in this setting.
Collapse
Affiliation(s)
- Ruoxi Liao
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Zhihong Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiancheng Wang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hairuo Lin
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Hairuo Lin, ,
| | - Huijun Sun
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China
- Huijun Sun,
| |
Collapse
|
7
|
Tsuji Y, Dobrev D. Chronic Total occlusion of infarct-related artery: A bystander or a risk factor of electrical storm? Int J Cardiol 2022; 359:36-37. [DOI: 10.1016/j.ijcard.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
|
8
|
Faga V, Anguera I, Oloriz T, Nombela-Franco L, Teruel L, Dallaglio P, Guerrero AP, Salazar CH, Escaned J, Abadía AA, Hospital JAG, García JR, García MR, Colet JC, Di Marco A. Improved prediction of electrical storm in patients with prior myocardial infarction and implantable cardioverter defibrillator. Int J Cardiol 2022; 355:9-14. [PMID: 35176405 DOI: 10.1016/j.ijcard.2022.02.016] [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: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
AIMS To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD). METHODS Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation. RESULTS During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p < 0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p = 0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%). CONCLUSION In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.
Collapse
Affiliation(s)
- Valentina Faga
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Ignasi Anguera
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Teresa Oloriz
- Cardiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Luis Teruel
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Paolo Dallaglio
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | | | | | - Javier Escaned
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Joan Antoni Gomez Hospital
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Julián Rodriguez García
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Marcos Rodriguez García
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Josep Comin Colet
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Andrea Di Marco
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain.
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
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: 0.6] [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.
Collapse
|
11
|
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: 1.6] [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.
Collapse
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
| |
Collapse
|
12
|
Di Marco A, Anguera I, Nombela‐Franco L, Oloriz T, Teruel L, Rodriguez Mañero M, Toquero J, León V, Dallaglio P, Perez Guerrero A, Salazar CH, Escaned J, Asso Abadía A, Gomez Hospital JA, Cequier A. Revascularization of coronary chronic total occlusions in an infarct‐related artery and recurrence of ventricular arrhythmias among patients with secondary prevention implantable cardioverter defibrillator. Catheter Cardiovasc Interv 2020; 97:E1-E11. [DOI: 10.1002/ccd.28915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/27/2020] [Accepted: 04/04/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Di Marco
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Ignasi Anguera
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | | | - Teresa Oloriz
- Cardiology Department Hospital Miguel Servet Zaragoza Spain
| | - Luis Teruel
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Moisés Rodriguez Mañero
- Cardiology Department Hospital Universitario Santiago de Compostela Santiago de Compostela Spain
| | - Jorge Toquero
- Cardiology Department Hospital Puerta del Hierro, Majadahonda Madrid Spain
| | - Valentina León
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Paolo Dallaglio
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | | | | | - Javier Escaned
- Cardiology Department Hospital Clínico San Carlos Madrid Spain
| | | | | | - Angel Cequier
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| |
Collapse
|
13
|
Kalnins A, Strele I, Lejnieks A. Comparison among Different Scoring Systems in Predicting Procedural Success and Long-Term Outcomes after Percutaneous Coronary Intervention in Patients with Chronic Total Coronary Artery Occlusions. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E494. [PMID: 31426403 PMCID: PMC6724017 DOI: 10.3390/medicina55080494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure. Materials and Methods: A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan-Meier method and Cox regression were used to estimate the association with death from any cause after a successful procedure, Results: 454 of 551cases were successful. With increasing disease complexity, the procedural success rate was significantly reduced in all scoring systems (p < 0.001): Area under the curve was 0.714 for J CTO score, 0.605 for PROGRESS CTO, 0.624 for CL and 0.641 for CASTLE scores. During the median 6.8 years of follow-up time, survival was better in the successful procedure group (p = 0.041). Among patients with procedural success, only PROGRESS and CASTLE scores showed an association with all-cause risk of death. After adjustment for baseline characteristics, patients having high PROGRESS score had almost twice higher risk of death (HR 1.81(95% CI 1.19-2.75)), and those with high and intermediate CASTLE score experienced almost four (HR 3.68(95% CI 1.50-9.05)) and two (HR 2.15, (95% CI 1.42-3.23)) times higher risk of death than the low score patients, respectively. Conclusions: All four CTO scoring systems had moderate ability to predict procedural success. More complex CTO PCI patients, assessed by PROGRESS and CASTLE scores, has worse all-cause survival in six to seven years after a successful procedure; whereas J CTO and CL scores had no association with survival.
Collapse
Affiliation(s)
- Artis Kalnins
- Clinic of Cardiovascular diseases, Riga East University Hospital, Riga, LV 1038, Latvia.
| | - Ieva Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, LV 1007, Latvia
| | - Aivars Lejnieks
- Clinic of Cardiovascular diseases, Riga East University Hospital, Riga, LV 1038, Latvia
- Department of Internal Diseases, Faculty of Medicine, Riga Stradins University, Riga, LV 1007, Latvia
| |
Collapse
|
14
|
Schumacher SP, Stuijfzand WJ, Opolski MP, van Rossum AC, Nap A, Knaapen P. Percutaneous Coronary Intervention of Chronic Total Occlusions: When and How to Treat. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:513-522. [DOI: 10.1016/j.carrev.2018.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 01/31/2023]
|
15
|
Chi WK, Gong M, Bazoukis G, Yan BP, Letsas KP, Liu T, Baranchuk A, Nombela-Franco L, Dong M, Tse G. 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: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
Collapse
Affiliation(s)
- Wai Kin Chi
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Adrian Baranchuk
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Mei Dong
- Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong Province, China.
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China.
| |
Collapse
|
16
|
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: 0.6] [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.
Collapse
|
17
|
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: 16] [Impact Index Per Article: 2.3] [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.
Collapse
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
| |
Collapse
|
18
|
Di Marco A, Oloriz Sanjuan T, Paglino G, Baratto F, Vergara P, Bisceglia C, Trevisi N, Sala S, Marzi A, Gulletta S, Cireddu M, Anguera I, Della Bella P. Late potentials abolition reduces ventricular tachycardia recurrence after ablation especially in higher-risk patients with a chronic total occlusion in an infarct-related artery. J Cardiovasc Electrophysiol 2018. [DOI: 10.1111/jce.13488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrea Di Marco
- Arrhythmia Unit, Heart Disease Institute; Bellvitge University Hospital; Barcelona Spain
| | - Teresa Oloriz Sanjuan
- Arrhythmia Unit; Hospital Miguel Servet; Zaragoza Spain
- Arrhythmia Unit; San Raffaele Hospital; Milán Italy
| | | | | | | | | | | | - Simone Sala
- Arrhythmia Unit; San Raffaele Hospital; Milán Italy
| | | | | | | | - Ignasi Anguera
- Arrhythmia Unit, Heart Disease Institute; Bellvitge University Hospital; Barcelona Spain
| | | |
Collapse
|