Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion.

BACKGROUND: Chronic total occlusion (CTO) is common in out-of-hospital cardiac arrest (OHCA) survivors with coronary artery disease. It is unclear whether CTO contributes to ventricular arrhythmias in this population. OBJECTIVE: This study sought to evaluate the impact of unrevascularized CTOs on the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy and all-cause mortality in OHCA survivors with coronary artery disease. METHODS: This was a retrospective study that included all consecutive OHCA survivors with coronary artery disease who received an ICD from December 1999 until June 2015. Study end points were appropriate ICD therapy and all-cause mortality. RESULTS: We identified 217 OHCA survivors (mean age 63 ± 10 years; 187 men (86%)) with coronary artery disease. Unrevascularized CTO was present in 71 of 217 patients (33%) at the time of ICD implantation. During a median follow-up of 61 months (interquartile range, 28-97 months), 57 of 217 patients (26%) experienced an appropriate ICD therapy. Patients with CTO had a higher incidence of appropriate ICD therapy in comparison to patients without CTO (log-rank, P = .002). Multivariate Cox regression analysis identified CTO (hazard ratio 2.07; 95% confidence interval 1.23-3.50; P = .007) as an independent predictor of appropriate ICD therapy. The presence of CTO was not associated with a higher mortality rate (log-rank, P = .18). CONCLUSIONS: In OHCA survivors with coronary artery disease receiving an ICD for secondary prevention, CTO was an independent predictor for the occurrence of ventricular arrhythmias but not for mortality.

Effect of Age and Renal Function on Survival After Left Ventricular Assist Device Implantation.

Left ventricular assist devices (LVAD) are increasingly used, especially as destination therapy in in older patients. The aim of this study was to evaluate the effect of age on renal function and mortality in the first year after implantation. A retrospective multicenter cohort study was conducted, evaluating all LVAD patients implanted in the 2 participating centers (age ≥18 years). Patients were stratified according to the age groups <45, 45-54, 55-64, and ≥65 years old. Overall, 241 patients were included (mean age 52.4 ± 12.9 years, 76% males, 33% destination therapy). The mean estimated Glomerular Filtration Rate (eGFR) at 1 year was 85, 72, 69, and 49 mL/min per 1.73 m2 in the age groups <45(n = 65, 27%), 45-54(n = 52, 22%), 55-64(n = 87, 36%), and ≥65 years (n = 37, 15%) p <0.001)), respectively. Older age and lower eGFR at baseline (p <0.01) were independent predictors of worse renal function at 1 year. The 1-year survival post-implantation was 79%,84%, 68%, and 54% for those in the age group <45, 45-54, 55-64 and ≥65 years (Log-rank p = 0.003). Older age, lower eGFR and, INTERMACS class I were independent predictors of 1-year mortality. Furthermore, older patients (age > 60 years) with an impaired renal function (eGFR <55 mL/min per 1.73 m2) had a 5-fold increased hazard ratio for mortality during the first year after implantation (p <0.001). In conclusion, age >60 years is an independent predictor for an impaired renal function and mortality. Older age combined with reduced renal function pre-implantation had a cumulative adverse effect on survival in patients receiving a LVAD.