Author + information
- Received August 31, 2016
- Revision received January 30, 2017
- Accepted February 9, 2017
- Published online May 1, 2017.
- Luis Nombela-Franco, MD, PhDa,∗ (, )
- Mario Iannaccone, MDb,
- Ignasi Anguera, MDc,
- Ignacio J. Amat-Santos, MD, PhDd,
- Manuel Sanchez-Garcia, MDe,
- Daniel Bautista, MDa,
- Martin N. Calvelo, MDf,
- Andrea Di Marco, MDc,
- Claudio Moretti, MD, PhDb,
- Roberto Pozzi, MDg,
- Marco Scaglione, MDh,
- Victoria Cañadas, MD, PhDa,
- María Sandin-Fuentes, MDd,
- Angel Arenal, MDf,
- Rodrigo Bagur, MD, PhDi,
- Nicasio Perez-Castellano, MD, PhDa,
- Cristina Fernandez-Perez, MD, PhDj,
- Fiorenzo Gaita, MDb,
- Carlos Macaya, MD, PhDa,
- Javier Escaned, MD, PhDa and
- Ignacio Fernández-Lozano, MD, PhDe
- aCardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
- bCittà della Scienza e della Salute, University of Turin, Turin, Italy
- cBellvitge University Hospital, Barcelona, Spain
- dInstitute of Heart Sciences, Centro de Investigación Biomédica En Red, Enfermedades Cardiovasculares, Hospital Clínico Universitario, Valladolid, Spain
- eHospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
- fHospital Universitario Gregorio Marañón, Madrid, Spain
- gSan Luigi Hospital, Orbassano, Italy
- hCardinal Massaia Hospital, Asti, Italy
- iCardiology Division, London Health Sciences Centre, Department of Medicine, Western University, London, Canada
- jEpidemiology and Statistical Department, Instituto de Investigación Sanitaria, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Luis Nombela-Franco, Cardiovascular Institute, Hospital Universitario Clínico San Carlos, C/ Prof. Martin Lagos s/n, 28040 Madrid, Spain.
Objectives This study sought to evaluate the incidence and clinical effect of coronary chronic total occlusions (CTOs) in patients with ischemic cardiomyopathy receiving an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD).
Background CTOs are common in patients with ischemic cardiomyopathy, which is the major cause of SCD. However, the impact of CTO in SCD survivors receiving an ICD is unknown.
Methods A total of 425 patients who had survived an episode of ventricular arrhythmias and underwent ICD implantation for secondary prevention in 8 centers were included. Coronary angiogram, CTO angiographic characteristics, and ventricular arrhythmia pattern were centrally analyzed. Primary and secondary endpoints were appropriate ICD therapies and mortality during a median follow-up of 4.1 years, according to the presence of CTO in the baseline angiogram.
Results Appropriate ICD therapies were higher in patients with CTO (51.7% vs. 36.3%; p = 0.001 at 4 years). Left ventricular ejection fraction (LVEF) (p = 0.015) and CTO (p = 0.001) were independent predictors of appropriate ICD therapy. Ventricular arrhythmia onset was associated to a shorter coupling interval and lower prematurity index in CTO patients. Defibrillator therapies were independently associated with worse LVEF (p = 0.046) and renal dysfunction (p = 0.023) among patients with CTO, and a tendency was observed in patients with better collateral flow (p = 0.093). Patients with poorer renal function (p = 0.029), LVEF (p = 0.041), and CTO (p = 0.033) experienced higher mortality rate.
Conclusions Among ICD recipients for secondary prevention of SCD, coronary CTO conferred a higher risk of VA recurrence and mortality in long-term follow-up. Angiographic and VA patterns could provide insights into the mechanisms of SCD and may have implications for the use of interventions designed to limit ICD shocks in this high-risk population.
- chronic total occlusion
- coronary artery disease
- implantable cardioverter-defibrillator
- ventricular arrhythmias
Dr. Fernández-Lozano has served on advisory boards for Boston Scientific and Sorin group; and is on a steering committee or study advisory committee for Medtronic and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2016.
- Revision received January 30, 2017.
- Accepted February 9, 2017.
- 2017 American College of Cardiology Foundation