Key result
In out-of-hospital cardiac arrest survivors without ST-segment elevation, an infarct-related artery chronic total occlusion was not independently associated with ventricular tachyarrhythmic events at 1 year (adjusted HR 1.2).
Why the study?
Chronic total coronary occlusion is a recognized risk factor for ventricular arrhythmias, especially in an infarct-related artery, but its effect in out-of-hospital cardiac arrest survivors without ST-segment elevation required evaluation.
Does the presence of an infarct-related chronic total coronary occlusion increase the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors without ST-segment elevation?
Cohort (n=163)
Yes
Does the presence of an infarct-related chronic total coronary occlusion increase the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors without ST-segment elevation?
In OHCA survivors without ST-segment elevation, severe left ventricular dysfunction (LVEF <35%), rather than the presence of an infarct-related chronic total occlusion, is the primary independent predictor of ventricular tachyarrhythmic events at 1 year.
LVEF <35% drives VTE risk in OHCA survivors without STE, not IRA-CTO; hypothesis-generating for refined risk models.
INTRODUCTION: Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. METHODS: We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. RESULTS: A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2-35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. CONCLUSION: In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.
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Graaf et al. (2021) conducted a cohort in Out-of-hospital cardiac arrest without ST-segment elevation (n=163). Infarct-related artery chronic total coronary occlusion (IRA-CTO) vs. No IRA-CTO was evaluated on Ventricular tachyarrhythmic event (VTE) (HR 1.2, 95% CI 0.4-4.3, p=0.74). In out-of-hospital cardiac arrest survivors without ST-segment elevation, an infarct-related artery chronic total occlusion was not independently associated with ventricular tachyarrhythmic events at 1 year (adjusted HR 1.2).
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