Key result
IRA-CTO revascularization linked to ~79% lower risk of sudden cardiac death or ventricular arrhythmias.
Why the study?
Chronic total occlusion has been associated with increased risk of sudden cardiac death and/or ventricular arrhythmias, but the impact of CTO revascularization on these outcomes was unclear.
Does CTO revascularization reduce sudden cardiac death and/or ventricular arrhythmias in patients with chronic total occlusion?
Does CTO revascularization reduce sudden cardiac death and/or ventricular arrhythmias in patients with chronic total occlusion?
While overall CTO revascularization does not significantly reduce sudden cardiac death or ventricular arrhythmias, targeted revascularization of an infarct-related artery CTO (IRA-CTO) is associated with a significant risk reduction.
May warrant targeted IRA-CTO revascularization to reduce arrhythmic risk; challenges neutral overall CTO data but remains hypothesis-generating.
Introduction: The presence of a chronic total occlusion (CTO) has been associated with increased risk of sudden cardiac death (SCD) and/or ventricular arrhythmias (VAs). This study aimed to evaluate the impact of CTO revascularization on SCD and/or VAs. Methods: A systematic review of the literature was performed to identify studies evaluating the association between CTO revascularization and risk of SCD and/or VAs. Results: Six studies were included in the final meta-analysis. The total sample size included 2,017 participants for the assessment of the primary outcome of interest and 868 participants for the assessment of the secondary outcome of interest. In 5 studies examining the association between CTO revascularization and risk of SCD and/or VAs, CTO revascularization was not associated with a statistically significant reduction in the risk of SCD and/or VAs (HR: 0.78; 95% CI: 0.38 to 1.60; p = 0.50, I2 = 87%). Conversely, in 2 studies examining the association between IRA-CTO revascularization and risk of SCD and/or VAs, IRA-CTO revascularization was associated with 79% lower risk of SCD and/or VAs (HR: 0.21; 95% CI: 0.10 to 0.43; p < 0.0001, I2 = 0%). Discussion: CTO revascularization overall was not associated with a lower risk of SCD and/or VAs. In contrast, IRA-CTO revascularization was associated with a lower risk of SCD and/or VAs. However, the study has several limitations, primarily due to the observational nature of the included studies. Conclusion: Successful revascularization of an IRA-CTO should be attempted to reduce the burden of VAs and reduce the risk of SCD.
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Sfairopoulos et al. (2026) studied this question. IRA-CTO revascularization was associated with a 79% lower risk of sudden cardiac death and/or ventricular arrhythmias (HR: 0.21).
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