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- Title
Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies.
- Authors
Di Marco, Andrea; Anguera, Ignasi; Teruel, Luis; Muntane, Guillem; Campbell, Niall G.; Fox, David J.; Brown, Benjamin; Skene, Chris; Davidson, Neil; Leon, Valentina; Dallaglio, Paolo; Elzein, Hind; Garcia‐Romero, Elena; Gomez‐Hospital, Joan Antoni; Cequier, Angel
- Abstract
Introduction Risk stratification for ventricular arrhythmias in patients with ischemic cardiomyopathy needs to be improved. Coronary chronic total occlusions in an infarct-related artery (IRA-CTOs) have been associated with an increased arrhythmic risk. This study aimed to evaluate the association between IRA-CTOs and appropriate implantable cardioverter-defibrillator (ICD) therapies. Methods and results Observational cohort study that included 342 patients with ischemic cardiomyopathy, an ICD implanted for primary or secondary prevention, and a coronary angiography performed shortly before ICD implantation. The ICD was implanted for primary prevention in 163 patients (48%). IRA-CTO was found in 161 patients (47%). During a median follow-up of 33 months, 41% of patients experienced at least one appropriate ICD therapy. Patients with IRA-CTO had higher proportions of appropriate ICD therapies (57% vs. 26%, P < 0.001) and appropriate ICD shocks (40% vs. 17%, P < 0.001). At multivariate Cox regression, IRA-CTO was the only variable that consistently resulted as independent predictor of appropriate ICD therapies and shocks both in the global population of the study (HR 2.3, P < 0.001 and HR 3, P < 0.001, respectively) and when analyzing separately patients with primary or secondary prevention ICD. Conclusions IRA-CTO is an independent predictor of appropriate ICD therapies, including appropriate ICD shocks. This association is consistent across all the subgroups analyzed. Patients with IRA-CTO have a very high risk of appropriate ICD therapies. These findings may help improving risk stratification as well as the management of ventricular arrhythmias in patients with ischemic cardiomyopathy.
- Subjects
CORONARY heart disease surgery; VENTRICULAR arrhythmia; CARDIOMYOPATHIES; CARDIAC patients; IMPLANTABLE cardioverter-defibrillators; LONGITUDINAL method; SCIENTIFIC observation; REGRESSION analysis; SURGERY; DISEASE risk factors
- Publication
Journal of Cardiovascular Electrophysiology, 2017, Vol 28, Issue 10, p1169
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.13290