Impact of Successful Chronic Coronary Total Occlusion Recanalization on Recurrence of Ventricular Arrhythmias in Implantable Cardioverter-Defibrillator Recipients for Ischemic Cardiomyopathy (VACTO PCI Study).
Cardiovasc Revasc Med
; 43: 104-111, 2022 10.
Article
in En
| MEDLINE
| ID: mdl-35398008
ABSTRACT
BACKGROUND:
Coronary chronic total occlusion lesions (CTOs) confer an increased risk of arrhythmic events among patients with ischemic cardiomyopathy (ICM) and implantable cardioverter-defibrillator (ICD) carriers, however the impact of CTO recanalization in this population remains unassessed.AIMS:
Evaluate the impact of CTOs percutaneous coronary interventions (PCI) on arrhythmic events.METHODS:
Patients with ICM and ICD from the VACTO I-II registries patients with medically treated CTO (CTO-OMT group) and without CTO (no-CTO group) were compared after inverse-probability-weighting adjustment (IPWT) with a similar population of consecutive patients undergoing CTO-PCI. The primary endpoint was appropriate ICD therapy. The secondary endpoint was all-cause mortality.RESULTS:
The total of 622 patients (mean age 67 ± 10 years, mean left ventricular ejection fraction 36 ± 11%) included in the analysis was composed by CTO-PCI patients n = 113, CTO-OMT patients n = 286, no-CTO patients n = 223. In the CTO-PCI group, compared to the CTO-OMT group, 5-year Kaplan Meier estimates for appropriate ICD therapy (20.4% vs. 56.4%, IPW-adjusted HR 0.45, 95% CI 0.29-0.71) and mortality (8.8% vs. 23%, IPW-adjusted HR 0.43, 95% CI 0.22-0.85) were lower, driven by infarct related artery CTO (IRA-CTO) PCI, while similar to those occurring in the no-CTO group.CONCLUSIONS:
In this large population, those with CTO receiving PCI had lower arrhythmic event rates and lower mortality compared to the CTO-OMT group, while showing an event rate similar to no-CTO patients. Sensitivity analyses suggest that the beneficial effect on the arrhythmic outcome was driven by IRA-CTO revascularization. CLASSIFICATION Chronic total occlusion.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Defibrillators, Implantable
/
Coronary Occlusion
/
Percutaneous Coronary Intervention
/
Cardiomyopathies
Type of study:
Etiology_studies
/
Risk_factors_studies
Limits:
Aged
/
Humans
/
Middle aged
Language:
En
Journal:
Cardiovasc Revasc Med
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2022
Document type:
Article