M van der Graaf1, L S D Jewbali1, J S Lemkes2, E M Spoormans2, M van der Ent3, M Meuwissen4, M J Blans5, P van der Harst6, J P Henriques7, A Beishuizen8, C Camaro9, G B Bleeker10, N van Royen9, S C Yap11. 1. Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. 2. Department of Cardiology, Amsterdam University Medical Centre VUMC, Amsterdam, The Netherlands. 3. Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands. 4. Department of Cardiology, Amphia Hospital, Breda, The Netherlands. 5. Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands. 6. Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands. 7. Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands. 8. Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands. 9. Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands. 10. Department of Cardiology, Haga Hospital, The Hague, The Netherlands. 11. Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. s.c.yap@erasmusmc.nl.
Abstract
INTRODUCTION:Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. METHODS: We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. RESULTS:A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2-35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. CONCLUSION: In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.
RCT Entities:
INTRODUCTION: Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. METHODS: We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. RESULTS: A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2-35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. CONCLUSION: In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.
Authors: Andrea Di Marco; Ignasi Anguera; Luis Teruel; Paolo Dallaglio; José González-Costello; Valentina León; Elaine Nuñez; Nicolás Manito; Joan Antoni Gómez-Hospital; Xavier Sabaté; Ángel Cequier Journal: Europace Date: 2017-02-01 Impact factor: 5.214
Authors: Amira Assaf; Roberto Diletti; Mark G Hoogendijk; Marisa van der Graaf; Felix Zijlstra; Tamas Szili-Torok; Sing-Chien Yap Journal: Expert Rev Cardiovasc Ther Date: 2020-08-01
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