TY - JOUR
T1 - Impact of chronic total occlusions and coronary revascularization on all-cause mortality and the incidence of ventricular arrhythmias in patients with ischemic cardiomyopathy
T2 - The study was presented at the SCAI 2014 Scientific Sessions, Las Vegas, Nevada.
AU - Raja, Vijay
AU - Wiegn, Phi
AU - Obel, Owen
AU - Christakopoulos, Georgios
AU - Christopoulos, George
AU - Rangan, Bavana V.
AU - Roesle, Michele
AU - Abdullah, Shuaib M.
AU - Luna, Michael
AU - Addo, Tayo
AU - Ayers, Colby
AU - Garcia, Santiago
AU - De Lemos, James A.
AU - Banerjee, Subhash
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Dr. Raja: none. Dr. Wiegn: none. Dr. Obel: none. Dr. Christakopoulos: none. Dr. Christopoulos: none. Dr. Javed: none. Ms. Roesle: none. Dr. Abdullah: none. Dr. Luna: research support from AstraZeneka. Dr. Addo: consulting fees from Abbott Vascular; speaker’s bureau: AstraZeneka. Mr. Ayers: none. Dr. Garcia: consulting fees from Medtronic and St. Jude Medical. Dr. Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development. Dr. de Lemos: consulting income from St. Jude Medical. Dr. Banerjee: consulting/speaker honoraria from Medtronic and Merck; research support from Boston Scientific and InfraRedx; intellectual property at HygeiaTel and MDCare Global. Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St Jude Medical, and Terumo; research support from Guerbet and InfraRedx; spouse is an employee of Medtronic.
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort.
AB - Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort.
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U2 - 10.1016/j.amjcard.2015.07.057
DO - 10.1016/j.amjcard.2015.07.057
M3 - Article
C2 - 26341182
AN - SCOPUS:84944354650
SN - 0002-9149
VL - 116
SP - 1358
EP - 1362
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 9
ER -