RT Journal Article
SR Electronic
T1 Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1096
OP 1102
DO 10.1136/heartjnl-2018-314076
VO 105
IS 14
A1 Cosmo Godino
A1 Alessia Giannattasio
A1 Andrea Scotti
A1 Luca Baldetti
A1 Carlo Andrea Pivato
A1 Andrea Munafò
A1 Alberto Cappelletti
A1 Alessandro Beneduce
A1 Francesco Melillo
A1 Mauro Chiarito
A1 Giuseppe Biondi Zoccai
A1 Giacomo Frati
A1 Gabriele Fragasso
A1 Lorenzo Azzalini
A1 Mauro Carlino
A1 Matteo Montorfano
A1 Alberto Margonato
A1 Antonio Colombo
YR 2019
UL http://heart.bmj.com/content/105/14/1096.abstract
AB 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 .