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Coronary artery disease
Original research article
Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion
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  • Published on: 26 June 2019
    The effect of chronic total occlusion revascularisation to the long-term outcome: what is the reason?
    • Daisuke Nitta, Cardiologist The University of Chicago Medicine
    • Other Contributors:
      • Teruhiko Imamura, Cardiologist

    To the Editor

    We read the article by Godino et al describing the risk of non-revascularisation of a coronary chronic total occlusion (CTO) for the cardiac death, sudden cardiac death and sustained ventricular arrhythmias (SCD/SVA) with great interest 1. After reading in detail, we have the following comments.
    At first, although the authors mentioned a little in the DISCUSSION, the effect of medications for the prevention of cardiac death and SCD/SVA may better be clarified in the subjects. As they stated, because those who received CTO lesion revascularisation tend to have longer dual antiplatelet therapy and receive more hospital visit for follow-up coronary angiography to recheck, there might be such confounding factors. For example, the third generation P2Y12 class of adenosine diphosphate (ADP) receptors inhibitor was approved in 2009 in Europe 2. How was its distribution compared to conventional clopidogrel treatment? And appropriate statin treatment would be also associated with plaque stability and reduced cardiac adverse events as well as the beta-blocker administration for the prevention of SCD/SVA 3. Because the follow-up period was long as up to 12-years, the difference of these medication strategies between two groups should be clarified. The same also applies to the used stent types. The importance of current manuscript would be much better after these concerns were clarified.
    Second, the multivariate analysis of Table 3 contains 2 factors,...

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    Conflict of Interest:
    None declared.