Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry.
This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy.



The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed.



The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443). The patients were divided into 2 groups with regard to CTO presence. All of the analyzed patients were followed up for at least 12 months with all-cause mortality defined as the primary endpoint.



Of the 675 patients fulfilling the inclusion and exclusion criteria, 278 patients (41.2%) had 1 or more CTOs of a major coronary artery (+CTO), and in 397 patients (58.8%) the presence of the CTO was not observed (-CTO). The 12-month mortality for the +CTO and -CTO patients was 19.4 % and 10.3 %, respectively (p < 0.001), evident also after 24 months (26.6% vs. 17.6%; p = 0.01). After a multivariate adjustment for differences in baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk: 1.84: 95% confidence interval: 1.18 to 2.85; p = 0.006).



Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze. Electronic address: mateusztajstra@wp.pl.
Mateusz
M
Tajstra
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Łukasz
Ł
Pyka
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Jarosław
J
Gorol
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Damian
D
Pres
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Marek
M
Gierlotka
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Elżbieta
E
Gadula-Gacek
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Anna
A
Kurek
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Michał
M
Wasiak
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Michał
M
Hawranek
Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze.
Michał Oskar
MO
Zembala
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Andrzej
A
Lekston
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Lech
L
Poloński
First Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University, Medical College, Kraków, Poland.
Leszek
L
Bryniarski
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Mariusz
M
Gąsior
D000368:Aged; D009202:Cardiomyopathies / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011044:Poland; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
cardiomyopathy; chronic total occlusion; heart failure; ischemic left ventricle dysfunction