Impact of a Chronic Total Coronary Occlusion on the Incidence of Appropriate Implantable Cardioverter-Defibrillator Shocks and Mortality: A Substudy of the Dutch Outcome in ICD Therapy (DO-IT)) Registry.

Autor: van Veelen A; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Verstraelen TE; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Somsen YBO; Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Elias J; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., van Dongen IM; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Delnoy PPHM; Department of Cardiology Isala Heart Center Zwolle The Netherlands., Scholten MF; Department of Cardiology Thorax Center Twente, Medisch Spectrum Twente Enschede The Netherlands., Boersma LVA; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands.; Department of Cardiology St. Antonius Hospital Nieuwegein The Netherlands., Maass AH; Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands., Strikwerda S; Department of Cardiology Amphia Hospitals Breda The Netherlands., Firouzi M; Department of Cardiology Maasstad Hospital Rotterdam The Netherlands., Allaart CP; Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Vernooy K; Department of Cardiology Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+) Maastricht The Netherlands., Grauss RW; Department of Cardiology Haaglanden Medical Center The Hague The Netherlands., Tukkie R; Department of Cardiology Spaarne Gasthuis Haarlem The Netherlands., Knaapen P; Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Zwinderman AH; Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands.; Methodology Amsterdam Public Health Amsterdam The Netherlands., Dijkgraaf MGW; Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands.; Methodology Amsterdam Public Health Amsterdam The Netherlands., Claessen BEPM; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., van Barreveld M; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands.; Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands.; Methodology Amsterdam Public Health Amsterdam The Netherlands., Wilde AAM; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands., Henriques JPS; Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Apr 16; Vol. 13 (8), pp. e032033. Date of Electronic Publication: 2024 Apr 09.
DOI: 10.1161/JAHA.123.032033
Abstrakt: Background: Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort.
Methods and Results: This is a subanalysis of the nationwide Dutch-Outcome in ICD Therapy (DO-IT) registry of primary prevention ICD recipients in The Netherlands between September 2014 and June 2016 (n=1442). We identified patients with chronic ischemic heart disease (n=663) and assessed available coronary angiograms for CTO presence (n=415). Patients with revascularized CTOs were excluded (n=79). The primary end point was the composite of all-cause mortality and appropriate ICD shocks. Clinical follow-up was conducted for at least 2 years. A total of 336 patients were included, with an average age of 67±9 years, and 20.5% was female (n=69). An unrevascularized CTO was identified in 110 patients (32.7%). During a median follow-up period of 27 months (interquartile range, 24-32), the primary end point occurred in 21.1% of patients with CTO (n=23) compared with 11.9% in patients without CTO (n=27; P =0.034). Corrected for baseline characteristics including left ventricular ejection fraction, and the presence of a CTO was an independent predictor for the primary end point (hazard ratio, 1.82 [95% CI, 1.03-3.22]; P =0.038).
Conclusions: Within this nationwide prospective registry of primary prevention ICD recipients, the presence of an unrevascularized CTO was an independent predictor for the composite outcome of all-cause mortality and appropriate ICD shocks.
Databáze: MEDLINE
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