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Godino, Cosmo; Giannattasio, Alessia; Scotti, Andrea; Baldetti, Luca; Pivato, Carlo Andrea; Munafò, Andrea; Cappelletti, Alberto; Beneduce, Alessandro; Melillo, Francesco; Chiarito, Mauro; Biondi Zoccai, Giuseppe; Frati, Giacomo; Fragasso, Gabriele; Azzalini, Lorenzo; Carlino, Mauro; Montorfano, Matteo; Margonato, Alberto; Colombo, Antonio

Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion

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  • Media type: E-Article
  • Title: Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion
  • Contributor: Godino, Cosmo; Giannattasio, Alessia; Scotti, Andrea; Baldetti, Luca; Pivato, Carlo Andrea; Munafò, Andrea; Cappelletti, Alberto; Beneduce, Alessandro; Melillo, Francesco; Chiarito, Mauro; Biondi Zoccai, Giuseppe; Frati, Giacomo; Fragasso, Gabriele; Azzalini, Lorenzo; Carlino, Mauro; Montorfano, Matteo; Margonato, Alberto; Colombo, Antonio
  • Published: BMJ, 2019
  • Published in: Heart, 105 (2019) 14, Seite 1096-1102
  • Language: English
  • DOI: 10.1136/heartjnl-2018-314076
  • ISSN: 1355-6037; 1468-201X
  • Origination:
  • Footnote:
  • Description: ObjectiveThe aim of this study is to evaluate the long-term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI).MethodsFrom a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs.ResultsUp to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients.ConclusionsAt long-term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events .