Impact of Chronic Total Occlusions and Coronary Revascularization on All-Cause Mortality and the Incidence of Ventricular Arrhythmias in Patients With Ischemic Cardiomyopathy.
Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort.
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Vijay
V
Raja
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Phi
P
Wiegn
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Owen
O
Obel
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas.
Georgios
G
Christakopoulos
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas.
George
G
Christopoulos
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Bavana V
BV
Rangan
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas.
Michele
M
Roesle
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Shuaib M
SM
Abdullah
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Michael
M
Luna
Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Tayo
T
Addo
Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Colby
C
Ayers
Department of Cardiovascular Diseases, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Cardiovascular Diseases, University of Minnesota, Minneapolis, Minnesota.
Santiago
S
Garcia
Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
James A
JA
de Lemos
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Subhash
S
Banerjee
Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, Texas; Department of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.
Emmanouil S
ES
Brilakis
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D009202:Cardiomyopathies / Q000150:complications*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology