Impact of successful chronic coronary total occlusion recanalization on recurrence of ventricular arrhythmias in implantable cardioverter-defibrillator recipients for ischemic cardiomyopathy (VACTO PCI study)

• Published in: Cardiovascular revascularization medicine Vol. 43; pp. 104 - 111
• Main Authors: Iannaccone, Mario, Nombela-Franco, Luis, Gallone, Guglielmo, Annone, Umberto, Di Marco, Andrea, Giannini, Francesco, Ayoub, Mohammed, Sardone, Andrea, Amat-Santos, Ignacio, Fernandez-Lozano, Ignacio, Barbero, Umberto, Dusi, Veronica, Toselli, Marco, Petretta, Andrea, de Salvia, Alberto, Boccuzzi, Giacomo, Colangelo, Salvatore, Anguera, Ignasi, D'Ascenzo, Fabrizio, Colombo, Antonio, De Ferrari, Gaetano Maria, Escaned, Javier, Garbo, Roberto, Mashayekhi, Kambis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2022
• Subjects: Chronic total occlusion; CTO; ICD therapy; PCI; Ventricular arrhythmias; Ventricular arrhythmias; ICD therapy; AAD; LVEF; ICD; VA; HFrEF; Chronic total occlusion; IRA-CTO; MACE; OMT; PCI; PVC; VT; CTO
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2022.03.029

Coronary chronic total occlusion lesions (CTOs) confer an increased risk of arrhythmic events among patients with ischemic cardiomyopathy (ICM) and implantable cardioverter-defibrillator (ICD) carriers, however the impact of CTO recanalization in this population remains unassessed. Evaluate the impact of CTOs percutaneous coronary interventions (PCI) on arrhythmic events. Patients with ICM and ICD from the VACTO I-II registries: patients with medically treated CTO (CTO-OMT group) and without CTO (no-CTO group) were compared after inverse-probability-weighting adjustment (IPWT) with a similar population of consecutive patients undergoing CTO-PCI. The primary endpoint was appropriate ICD therapy. The secondary endpoint was all-cause mortality. The total of 622 patients (mean age 67 ± 10 years, mean left ventricular ejection fraction 36 ± 11%) included in the analysis was composed by: CTO-PCI patients n = 113, CTO-OMT patients n = 286, no-CTO patients n = 223. In the CTO-PCI group, compared to the CTO-OMT group, 5-year Kaplan Meier estimates for appropriate ICD therapy (20.4% vs. 56.4%, IPW-adjusted HR: 0.45, 95% CI 0.29–0.71) and mortality (8.8% vs. 23%, IPW-adjusted HR: 0.43, 95% CI 0.22–0.85) were lower, driven by infarct related artery CTO (IRA-CTO) PCI, while similar to those occurring in the no-CTO group. In this large population, those with CTO receiving PCI had lower arrhythmic event rates and lower mortality compared to the CTO-OMT group, while showing an event rate similar to no-CTO patients. Sensitivity analyses suggest that the beneficial effect on the arrhythmic outcome was driven by IRA-CTO revascularization. Chronic total occlusion. Coronary chronic total occlusion lesions (CTOs) confer an increased risk of arrhythmic events among patients with ischemic cardiomyopathy (ICM) and implantable cardioverter-defibrillator (ICD) carriers. Our data shows in this large population of patients with ICM and ICD, those with CTO receiving PCI had lower arrhythmic event rates and lower mortality compared to the CTO-OMT group, while showing an event rate similar to no-CTO patients. Sensitivity analyses suggest that the beneficial effect on the arrhythmic outcome was driven by infarct related artery CTO revascularization. [Display omitted] •CTOs confer an increased risk of ventricular arrhythmias among patients with ischemic cardiomyopathy and an ICD implanted.•The present study shows that CTO PCI is associated with the reduction of the arrhythmic burden and all-cause mortality.•Ischemic border-zone reversal by CTO recanalization potentially lower the burden of ventricular arrhythmias.