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

• Published in: JACC. Cardiovascular interventions Vol. 9; no. 17; pp. 1790 - 1797
• Main Authors: Tajstra, Mateusz, Pyka, Łukasz, Gorol, Jarosław, Pres, Damian, Gierlotka, Marek, Gadula-Gacek, Elżbieta, Kurek, Anna, Wasiak, Michał, Hawranek, Michał, Zembala, Michał Oskar, Lekston, Andrzej, Poloński, Lech, Bryniarski, Leszek, Gąsior, Mariusz
• Format: Journal Article
• Language: English
• Published: United States 12.09.2016
• Subjects: Aged; Cardiomyopathies - complications; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Chi-Square Distribution; Chronic Disease; Coronary Angiography; Coronary Occlusion - complications; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - mortality; Coronary Occlusion - physiopathology; Female; Heart Failure, Systolic - diagnostic imaging; Heart Failure, Systolic - etiology; Heart Failure, Systolic - mortality; Heart Failure, Systolic - physiopathology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Poland; Prognosis; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Time Factors; heart failure; chronic total occlusion; ischemic left ventricle dysfunction; cardiomyopathy
• DOI: 10.1016/j.jcin.2016.06.007

This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy. 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. 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. 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). Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.