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Observational Study
. 2016 Sep 12;9(17):1790-7.
doi: 10.1016/j.jcin.2016.06.007.

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

Mateusz Tajstra  1 , Łukasz Pyka  2 , Jarosław Gorol  2 , Damian Pres  2 , Marek Gierlotka  2 , Elżbieta Gadula-Gacek  2 , Anna Kurek  2 , Michał Wasiak  2 , Michał Hawranek  2 , Michał Oskar Zembala  3 , Andrzej Lekston  2 , Lech Poloński  2 , Leszek Bryniarski  4 , Mariusz Gąsior  2
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Free article
Observational Study

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

Mateusz Tajstra et al. JACC Cardiovasc Interv. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Cardiovasc Interv. 2016 Oct 24;9(20):2181-2182. doi: 10.1016/j.jcin.2016.09.033. JACC Cardiovasc Interv. 2016. PMID: 27765323 No abstract available.
  • Correction.
    [No authors listed] [No authors listed] JACC Cardiovasc Interv. 2017 Jun 26;10(12):1282. doi: 10.1016/j.jcin.2017.05.045. JACC Cardiovasc Interv. 2017. PMID: 28641858 No abstract available.

Abstract

Objectives: This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy.

Background: 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.

Methods: 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.

Results: 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).

Conclusions: Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.

Keywords: cardiomyopathy; chronic total occlusion; heart failure; ischemic left ventricle dysfunction.

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