Barbara E Stähli1, Cathérine Gebhard2, Michael Gick2, Kambis Mashayekhi2, Miroslaw Ferenc2, Heinz Joachim Buettner2, Franz-Josef Neumann2, Aurel Toma3. 1. Department of Cardiology, Charité Berlin, University Medicine, Campus Benjamin Franklin, Berlin, Germany. 2. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany. 3. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany. toma.aurel@gmail.com.
Abstract
BACKGROUND: Successful CTO recanalization has been associated with clinical benefit. Outcomes of patients with atrial fibrillation undergoing CTO PCI have not been investigated, yet. AIMS: This study sought to evaluate the association between atrial fibrillation and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). METHODS: Consecutive patients undergoing CTO PCI between January 2005 and December 2013 were divided into patients with and without atrial fibrillation, and propensity-matched models used to adjust for baseline differences between groups. The primary outcome was all-cause mortality at a median follow-up of 3.2 (interquartile range 3.1-4.5) years. RESULTS: Of 2002 patients undergoing CTO PCI, atrial fibrillation was present in 169 (8.4%) patients. Patients with atrial fibrillation were older, and more frequently had hypertension, left ventricular systolic dysfunction, and chronic kidney disease. Before matching, all-cause mortality was 39.6 and 14.5% in the atrial fibrillation and the sinus rhythm groups (HR 2.92, 95% CI 2.23-3.82, p < 0.001). In the propensity-matched model, atrial fibrillation remained associated with an increased risk of mortality (HR 1.62, 95% CI 1.06-2.47, p = 0.03). In the unmatched patient cohort, all-cause mortality was significantly reduced in patients with procedural success, both in the atrial fibrillation (34.9 versus 55.0%, adjusted HR 0.99, 95% CI 0.97-1.00, p = 0.02) and the sinus rhythm groups (12.8 versus 23.0%, adjusted HR 0.70, 95% CI 0.53-0.92, p = 0.01). CONCLUSIONS: Although atrial fibrillation is independently associated with mortality after CTO PCI, substantial survival benefit of successful CTO recanalization is observed in both patients with and without atrial fibrillation.
BACKGROUND: Successful CTO recanalization has been associated with clinical benefit. Outcomes of patients with atrial fibrillation undergoing CTO PCI have not been investigated, yet. AIMS: This study sought to evaluate the association between atrial fibrillation and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). METHODS: Consecutive patients undergoing CTO PCI between January 2005 and December 2013 were divided into patients with and without atrial fibrillation, and propensity-matched models used to adjust for baseline differences between groups. The primary outcome was all-cause mortality at a median follow-up of 3.2 (interquartile range 3.1-4.5) years. RESULTS: Of 2002 patients undergoing CTO PCI, atrial fibrillation was present in 169 (8.4%) patients. Patients with atrial fibrillation were older, and more frequently had hypertension, left ventricular systolic dysfunction, and chronic kidney disease. Before matching, all-cause mortality was 39.6 and 14.5% in the atrial fibrillation and the sinus rhythm groups (HR 2.92, 95% CI 2.23-3.82, p < 0.001). In the propensity-matched model, atrial fibrillation remained associated with an increased risk of mortality (HR 1.62, 95% CI 1.06-2.47, p = 0.03). In the unmatched patient cohort, all-cause mortality was significantly reduced in patients with procedural success, both in the atrial fibrillation (34.9 versus 55.0%, adjusted HR 0.99, 95% CI 0.97-1.00, p = 0.02) and the sinus rhythm groups (12.8 versus 23.0%, adjusted HR 0.70, 95% CI 0.53-0.92, p = 0.01). CONCLUSIONS: Although atrial fibrillation is independently associated with mortality after CTO PCI, substantial survival benefit of successful CTO recanalization is observed in both patients with and without atrial fibrillation.
Entities:
Keywords:
Atrial fibrillation; Chronic total occlusion; Percutaneous coronary intervention
Authors: S S Rathore; A K Berger; K P Weinfurt; K A Schulman; W J Oetgen; B J Gersh; A J Solomon Journal: Circulation Date: 2000-03-07 Impact factor: 29.690
Authors: Georgios Sianos; Gerald S Werner; Alfredo R Galassi; Michail I Papafaklis; Javier Escaned; David Hildick-Smith; Evald Høj Christiansen; Anthony Gershlick; Mauro Carlino; Angelos Karlas; Nikolaos V Konstantinidis; Salvatore D Tomasello; Carlo Di Mario; Nicolaus Reifart Journal: EuroIntervention Date: 2012-05-15 Impact factor: 6.534
Authors: Loes P Hoebers; Bimmer E Claessen; Joelle Elias; George D Dangas; Roxana Mehran; José P S Henriques Journal: Int J Cardiol Date: 2015-03-17 Impact factor: 4.164
Authors: Ali Ahmed; Michael W Rich; Thomas E Love; Donald M Lloyd-Jones; Inmaculada B Aban; Wilson S Colucci; Kirkwood F Adams; Mihai Gheorghiade Journal: Eur Heart J Date: 2005-12-08 Impact factor: 29.983
Authors: Miklos Rohla; Christoph Kleine Vennekate; Ioannis Tentzeris; Matthias K Freynhofer; Serdar Farhan; Florian Egger; Thomas W Weiss; Johann Wojta; Christopher B Granger; Kurt Huber Journal: Int J Cardiol Date: 2015-02-10 Impact factor: 4.164
Authors: Renato D Lopes; Laine E Elliott; Harvey D White; Judith S Hochman; Frans Van de Werf; Diego Ardissino; Torsten T Nielsen; W Douglas Weaver; Petr Widimsky; Paul W Armstrong; Christopher B Granger Journal: Eur Heart J Date: 2009-06-06 Impact factor: 29.983
Authors: Tommy Andersson; Anders Magnuson; Ing-Liss Bryngelsson; Ole Frøbert; Karin M Henriksson; Nils Edvardsson; Dritan Poçi Journal: Eur Heart J Date: 2013-01-14 Impact factor: 29.983
Authors: Insa E Emrich; Adam M Zawada; Jens Martens-Lobenhoffer; Danilo Fliser; Stefan Wagenpfeil; Gunnar H Heine; Stefanie M Bode-Böger Journal: Clin Res Cardiol Date: 2017-11-03 Impact factor: 5.460