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).

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.

• Authors: Ivo M van Dongen, Dilek Yilmaz, Joëlle Elias, Bimmer E P M Claessen, Ronak Delewi, Reinoud E Knops, Arthur A M Wilde, Lieselot van Erven, Martin J Schalij, José P S Henriques
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 7 Issue 10 (05 02 2018) ISSN: 2047-9980 [Electronic] England
• PMID: 29720502 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Topics

• Aged
• Arrhythmias, Cardiac (mortality, physiopathology, prevention & control)
• Cardiomyopathies (mortality, physiopathology, therapy)
• Chronic Disease
• Collateral Circulation
• Coronary Circulation
• Coronary Occlusion (epidemiology, mortality, physiopathology)
• Defibrillators, Implantable
• Electric Countershock (adverse effects, instrumentation, mortality)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Myocardial Ischemia (epidemiology, mortality, physiopathology)
• Netherlands (epidemiology)
• Primary Prevention (instrumentation)
• Registries
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Secondary Prevention (instrumentation)
• Time Factors
• Treatment Outcome
• Ventricular Function, Left