Cardiac and sudden death after chronic total occlusion percutaneous coronary intervention: Prognostic role of the target vessel

Abstract

Background The role of the target vessel in percutaneous revascularization of chronic total occlusion (CTO) is unclear. Objective We sought to assess the long‐term results of percutaneous coronary intervention (PCI) for CTO lesions in each coronary artery and to investigate the impact of successful revascularization and previous myocardial infarction (MI) in the territory of the target vessel. Methods and Results Cohort observational study on 1,124 patients who have undergone CTO PCI attempt: 371 on left anterior descending artery (LAD), 485 right coronary artery, and 268 left circumflex. Patients were further stratified by successfully revascularized and not‐revascularized CTO (CTO‐NR). Vessels affected by a previous MI were defined as infarct‐related artery (IRA). The primary endpoint was cardiac death; the secondary endpoint was the combined rate of sudden cardiac‐death and sustained ventricular‐arrhythmias (SCD/SVAs). Propensity score‐matching was performed to evaluate LAD versus NON‐LAD CTO. Up to 12‐year follow‐up, the clinical benefit associated with successful PCI was consistent across the three groups. CTO‐NR had the greatest association with cardiac death and SCD/SVAs in each coronary artery and in IRA‐CTO patients. Conclusions Unsuccessful percutaneous CTO revascularization was associated with lower cardiac survival and freedom from SCD/SVAs, irrespective of the vessel treated. This result was mainly driven by patients with an IRA CTO.

The impact of chronic total occlusions in patients undergoing transcatheter aortic valve replacement: A systematic review and meta‐analysis

“…34 In addition, malignant arrhythmias may have an important role in the pathophysiology of cardiovascular death in patients with coronary CTOs. 20,[30][31][32]35,36 Moreover, it has been suggested that nonrevascularized CTOs may be associated with impaired LVEF which is a well-established prognostic marker for major adverse cardiovascular events. 16 However, in the case of patients undergoing TAVR the risk is different from that of acute myocardial infarction.…”

“…In case of an acute vessel closure in the collateral donor artery mortality increases to an excessive 52% 34 . In addition, malignant arrhythmias may have an important role in the pathophysiology of cardiovascular death in patients with coronary CTOs 20,30–32,35,36 . Moreover, it has been suggested that nonrevascularized CTOs may be associated with impaired LVEF which is a well‐established prognostic marker for major adverse cardiovascular events 16 .…”