Key result
Successful CTO PCI shows no benefit over failed or untreated lesions for sustained ventricular arrhythmias.
Why the study?
Although chronic total coronary occlusion is linked to ventricular arrhythmias in patients with an ICD, limited data exist on the incidence of ventricular arrhythmias in CTO patients without an ICD.
Does successful CTO revascularization reduce the incidence of sustained ventricular arrhythmias compared to untreated or failed CTO revascularization in patients with LVEF >35%?
Observational (n=90)
Yes
Does successful CTO revascularization reduce the incidence of sustained ventricular arrhythmias compared to untreated or failed CTO revascularization in patients with LVEF >35%?
Absolute Event Rate: 8.8% vs 4.5%
p-value: p=0.71
In patients with a chronic total occlusion and LVEF >35%, the incidence of sustained ventricular arrhythmias is substantial but does not significantly differ between those who undergo successful revascularization and those managed conservatively.
CTO revascularization was not linked to lower VA rates in LVEF >35%; hypothesis-generating and should not change practice pending RCTs.
Background: A chronic total coronary occlusion (CTO) is associated with ventricular arrhythmias (VA) in patients with an implantable cardioverter-defibrillator (ICD). Limited data is available on the incidence of VA in CTO patients without an ICD. Objectives: To investigate the incidence of sustained VA in CTO patients after successful CTO revascularization and in patients with untreated CTO or failed CTO revascularization. Methods: Prospective, multicenter observational pilot study including CTO patients who were not eligible for an ICD and had a left ventricular ejection fraction >35 %. We enrolled patients with a successful CTO revascularization (group A) and patients with untreated CTO or failed CTO revascularization (group B). All patients received an implantable loop recorder with remote monitoring. The primary endpoint was sustained VA. Results: Ninety patients were enrolled (mean age 63 ± 10 years, 83.3 % man, mean LVEF 55 ± 8 %). Group A (n = 45) had a higher prevalence of CTO in the left anterior descending artery in comparison to group B (n = 45) (28.9 % versus 4.4 %, P = 0.002). Other baseline characteristics were similar. During a median follow-up time of 26 months (IQR, 19-35), five patients (5.6 %) had a sustained VA. There was no difference in the incidence of sustained VA between groups (3-year cumulative event rate: 8.8 % (group A) versus 4.5 % (Group B), log-rank P = 0.71). Conclusion: Patients with an CTO, who do not qualify for an ICD, have a substantial risk of sustained VA. In our study the incidence was not different between patients with revascularized and those with untreated CTO.
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Assaf et al. (2023) conducted an observational in Chronic total coronary occlusion (n=90). Successful CTO revascularization vs. Untreated CTO or failed CTO revascularization was evaluated on Sustained ventricular arrhythmias (VA lasting > 30 s or ventricular fibrillation) (p=0.71). In patients with chronic total coronary occlusion not qualifying for an ICD, the 3-year cumulative event rate of sustained ventricular arrhythmias was not significantly different between those with successful revascularization (8.8%) and those with untreated or failed revascularization (4.5%).
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