Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study)

Nombela‐Franco, Luis; Iannaccone, Mario; Anguera, Ignasi; Amat‐Santos, Ignacio J.; Sánchez-García, Manuel; Bautista, Daniel; Calvelo, Martin N.; Marco, Andrea Di; Moretti, Claudio; Pozzi, Roberto; Scaglione, Mariano; Cañadas, Victoria; Sandín‐Fuentes, María; Arenal, Ángel; Bagur, Rodrigo; Pérez‐Castellano, Nicasio; Fernández‐Pérez, Cristina; Gaïta, Fiorenzo; Macaya, Carlos; Escaned, Javier; Fernández‐Lozano, Ignacio

doi:10.1016/j.jcin.2017.02.008

Cited by 70 publications

(71 citation statements)

References 32 publications

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“…Previous published studies8, 9, 10, 16, 17 have shown a trend towards higher appropriate device therapy and all‐cause mortality rates in ICD patients with a CTO. Also, the presence of a CTO has proven to be associated with a worse survival compared with patients with SVD or MVD without a CTO 3, 4.…”

Section: Discussionmentioning

confidence: 92%

“…In Figure 4A and 4B, an overview of the available event rates for all‐cause death and appropriate device therapy of all studies on this subject is depicted 8, 9, 10. Event rates were numerically higher in CTO patients with an ICD for ICM, compared with patients without a CTO.…”

Section: Resultsmentioning

confidence: 99%

“…In our cohort of stable ICD patients, we found no clear effect of the quality of collateral vessels on survival or on appropriate device therapy, although appropriate device therapy appeared to occur more frequently in patients with well‐developed collaterals. In the VACTO secondary (impact of chronic total coronary occlusion on recurrence of ventricular arrhythmias in ischemic secondary prevention implantable cardioverter‐defibrillator recipients) study, a trend towards more appropriate therapy was observed in patients with Rentrop 3 collaterals 9. The authors hypothesize that hibernating myocardium may explain this finding 9.…”

Section: Discussionmentioning

confidence: 99%

“…In the VACTO secondary (impact of chronic total coronary occlusion on recurrence of ventricular arrhythmias in ischemic secondary prevention implantable cardioverter‐defibrillator recipients) study, a trend towards more appropriate therapy was observed in patients with Rentrop 3 collaterals 9. The authors hypothesize that hibernating myocardium may explain this finding 9. In patients with good collateral filling of the CTO vessel, more viability could be present, especially in a border zone around the necrotic core of the area affected by the CTO 9.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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BackgroundPrevious studies report conflicting results about a higher incidence of ventricular arrhythmias in patients with a chronic total coronary occlusion (CTO). We aimed to investigate this association in a large cohort of implantable cardioverter defibrillator patients with long‐term follow‐up.Methods and ResultsAll consecutive patients from 1992 onwards who underwent implantable cardioverter defibrillator implantation for ischemic cardiomyopathy at the Leiden University Medical Center were evaluated. Coronary angiograms were reviewed for the presence of a CTO. The occurrence of ventricular arrhythmias and survival status at follow‐up were compared between patients with and patients without a CTO. A total of 722 patients constitute the study cohort (age 66±11 years; 84% males; 74% primary prevention, median left ventricular ejection fraction 30% [first–third quartile: 25–37], 44% received a cardiac resynchronization therapy defibrillator). At baseline, 240 patients (33%) had a CTO, and the CTOs were present for at least 44 (2–127) months. The median follow‐up duration was 4 (2–6) years. On long‐term follow‐up, CTO patients had a higher crude appropriate device therapy rate (37% versus 27%, P=0.010) and a lower crude survival rate (51% versus 67%, P<0.001) compared with patients without a CTO. Corrected for baseline characteristics including left ventricular ejection fraction, the presence of a CTO was an independent predictor for appropriate device therapy.ConclusionsThe presence of a CTO in implantable cardioverter defibrillator patients was associated with more appropriate device therapy and worse prognosis at long‐term follow‐up. Further investigation is warranted regarding a potential beneficial effect of CTO revascularization on the incidence of ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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“…At least one CTO was present in 44% of the patients and was independently associated with appropriate ICD therapy (adjusted HR, 3.5; 95% CI, 1.5–8.3; P =0.003) and mortality (adjusted HR, 5.6; 95% CI, 1.4–21; P =0.02) during a median follow‐up of 257 days 19. In another study of 425 patients who had a prior ventricular arrhythmia and underwent ICD implantation, the incidence of appropriate ICD therapy was significantly higher in patients with CTOs (51.7% versus 36.3%; P =0.0001) 20. Raja et al21 compared long‐term mortality and the incidence of ventricular arrhythmias in patients with ischemic cardiomyopathy and ICD (n=307) divided into 3 groups: no CTOs (n=94), nonrevascularized CTOs (n=114), and revascularized CTOs (n=99).…”

Section: Clinical Benefitsmentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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Coronary Angiography After Cardiac Arrest Without ST Segment Elevation

et al. 2020

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IMPORTANCE Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking.OBJECTIVE To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. DESIGN, SETTING, AND PARTICIPANTSA prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019.INTERVENTIONS Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery.MAIN OUTCOMES AND MEASURES Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year.RESULTS At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). CONCLUSIONS AND RELEVANCEIn this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. TRIAL REGISTRATION trialregister.nl Identifier: NTR4973

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Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study)

Cited by 70 publications

References 32 publications

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Coronary Angiography After Cardiac Arrest Without ST Segment Elevation

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