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. 2024 Apr 16;13(8):e032033.
doi: 10.1161/JAHA.123.032033. Epub 2024 Apr 9.

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

Anna van Veelen  1 , Tom E Verstraelen  1 , Yvemarie B O Somsen  2 , Joëlle Elias  1 , Ivo M van Dongen  1 , Peter Paul H M Delnoy  3 , Marcoen F Scholten  4 , Lucas V A Boersma  1   5 , Alexander H Maass  6 , Sipke Strikwerda  7 , Mehran Firouzi  8 , Cornelis P Allaart  2 , Kevin Vernooy  9 , Robert W Grauss  10 , Raymond Tukkie  11 , Paul Knaapen  2 , Aeilko H Zwinderman  12   13 , Marcel G W Dijkgraaf  12   13 , Bimmer E P M Claessen  1 , Marit van Barreveld  1   12   13 , Arthur A M Wilde  1 , José P S Henriques  1 ; DO‐IT investigators *
Collaborators, Affiliations

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

Anna van Veelen et al. J Am Heart Assoc. .

Abstract

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.

Keywords: chronic ischemic heart disease; chronic total occlusion; coronary artery disease; implantable cardioverter defibrillator.

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Figures

Figure 1
Figure 1. Flowchart of patient selection.
CABG indicates coronary artery bypass grafting; CAG, coronary angiogram; CTO, chronic total occlusion; DO‐IT, Dutch‐Outcome in ICD Therapy; ICD, implantable cardioverter defibrillator; and PCI, percutaneous coronary intervention.
Figure 2
Figure 2. Cumulative event rate for the combination of all‐cause mortality and appropriate ICD shock, stratified for the presence of a CTO.
CTO indicates chronic total occlusion; and ICD, implantable cardioverter defibrillator.
See this image and copyright information in PMC

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