%0 Journal Article %A Cosmo Godino %A Alessia Giannattasio %A Andrea Scotti %A Luca Baldetti %A Carlo Andrea Pivato %A Andrea Munafò %A Alberto Cappelletti %A Alessandro Beneduce %A Francesco Melillo %A Mauro Chiarito %A Giuseppe Biondi Zoccai %A Giacomo Frati %A Gabriele Fragasso %A Lorenzo Azzalini %A Mauro Carlino %A Matteo Montorfano %A Alberto Margonato %A Antonio Colombo %T Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion %D 2019 %R 10.1136/heartjnl-2018-314076 %J Heart %P 1096-1102 %V 105 %N 14 %X Objective The 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).Methods From 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.Results Up 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.Conclusions At 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 . %U https://heart.bmj.com/content/heartjnl/105/14/1096.full.pdf