Luis Nombela-Franco1, Mario Iannaccone2, Ignasi Anguera3, Ignacio J Amat-Santos4, Manuel Sanchez-Garcia5, Daniel Bautista6, Martin N Calvelo7, Andrea Di Marco3, Claudio Moretti2, Roberto Pozzi8, Marco Scaglione9, Victoria Cañadas6, María Sandin-Fuentes4, Angel Arenal7, Rodrigo Bagur10, Nicasio Perez-Castellano6, Cristina Fernandez-Perez11, Fiorenzo Gaita2, Carlos Macaya6, Javier Escaned6, Ignacio Fernández-Lozano5. 1. Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain. Electronic address: luisnombela@yahoo.com. 2. Città della Scienza e della Salute, University of Turin, Turin, Italy. 3. Bellvitge University Hospital, Barcelona, Spain. 4. Institute of Heart Sciences, Centro de Investigación Biomédica En Red, Enfermedades Cardiovasculares, Hospital Clínico Universitario, Valladolid, Spain. 5. Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. 6. Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain. 7. Hospital Universitario Gregorio Marañón, Madrid, Spain. 8. San Luigi Hospital, Orbassano, Italy. 9. Cardinal Massaia Hospital, Asti, Italy. 10. Cardiology Division, London Health Sciences Centre, Department of Medicine, Western University, London, Canada. 11. Epidemiology and Statistical Department, Instituto de Investigación Sanitaria, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
Abstract
OBJECTIVES: This study sought to evaluate the incidence and clinical effect of coronary chronic total occlusions (CTOs) in patients with ischemic cardiomyopathy receiving an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD). BACKGROUND: CTOs are common in patients with ischemic cardiomyopathy, which is the major cause of SCD. However, the impact of CTO in SCD survivors receiving an ICD is unknown. METHODS: A total of 425 patients who had survived an episode of ventricular arrhythmias and underwent ICD implantation for secondary prevention in 8 centers were included. Coronary angiogram, CTO angiographic characteristics, and ventricular arrhythmia pattern were centrally analyzed. Primary and secondary endpoints were appropriate ICD therapies and mortality during a median follow-up of 4.1 years, according to the presence of CTO in the baseline angiogram. RESULTS: Appropriate ICD therapies were higher in patients with CTO (51.7% vs. 36.3%; p = 0.001 at 4 years). Left ventricular ejection fraction (LVEF) (p = 0.015) and CTO (p = 0.001) were independent predictors of appropriate ICD therapy. Ventricular arrhythmia onset was associated to a shorter coupling interval and lower prematurity index in CTO patients. Defibrillator therapies were independently associated with worse LVEF (p = 0.046) and renal dysfunction (p = 0.023) among patients with CTO, and a tendency was observed in patients with better collateral flow (p = 0.093). Patients with poorer renal function (p = 0.029), LVEF (p = 0.041), and CTO (p = 0.033) experienced higher mortality rate. CONCLUSIONS: Among ICD recipients for secondary prevention of SCD, coronary CTO conferred a higher risk of VA recurrence and mortality in long-term follow-up. Angiographic and VA patterns could provide insights into the mechanisms of SCD and may have implications for the use of interventions designed to limit ICD shocks in this high-risk population.
OBJECTIVES: This study sought to evaluate the incidence and clinical effect of coronary chronic total occlusions (CTOs) in patients with ischemic cardiomyopathy receiving an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD). BACKGROUND: CTOs are common in patients with ischemic cardiomyopathy, which is the major cause of SCD. However, the impact of CTO in SCD survivors receiving an ICD is unknown. METHODS: A total of 425 patients who had survived an episode of ventricular arrhythmias and underwent ICD implantation for secondary prevention in 8 centers were included. Coronary angiogram, CTO angiographic characteristics, and ventricular arrhythmia pattern were centrally analyzed. Primary and secondary endpoints were appropriate ICD therapies and mortality during a median follow-up of 4.1 years, according to the presence of CTO in the baseline angiogram. RESULTS: Appropriate ICD therapies were higher in patients with CTO (51.7% vs. 36.3%; p = 0.001 at 4 years). Left ventricular ejection fraction (LVEF) (p = 0.015) and CTO (p = 0.001) were independent predictors of appropriate ICD therapy. Ventricular arrhythmia onset was associated to a shorter coupling interval and lower prematurity index in CTOpatients. Defibrillator therapies were independently associated with worse LVEF (p = 0.046) and renal dysfunction (p = 0.023) among patients with CTO, and a tendency was observed in patients with better collateral flow (p = 0.093). Patients with poorer renal function (p = 0.029), LVEF (p = 0.041), and CTO (p = 0.033) experienced higher mortality rate. CONCLUSIONS: Among ICD recipients for secondary prevention of SCD, coronary CTO conferred a higher risk of VA recurrence and mortality in long-term follow-up. Angiographic and VA patterns could provide insights into the mechanisms of SCD and may have implications for the use of interventions designed to limit ICD shocks in this high-risk population.
Authors: Leszek Bryniarski; Maksymilian P Opolski; Jarosław Wójcik; Maciej Lesiak; Tomasz Pawłowski; Jakub Drozd; Wojciech Wojakowski; Sławomir Surowiec; Maciej Dąbrowski; Adam Witkowski; Dariusz Dudek; Marek Grygier; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426
Authors: Ivo M van Dongen; Dilek Yilmaz; Joëlle Elias; Bimmer E P M Claessen; Ronak Delewi; Reinoud E Knops; Arthur A M Wilde; Lieselot van Erven; Martin J Schalij; José P S Henriques Journal: J Am Heart Assoc Date: 2018-05-02 Impact factor: 5.501