Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies
Corresponding Author
Andrea Di Marco MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Correspondence
Andrea Di Marco, MD, Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorIgnasi Anguera MD, PhD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorLuis Teruel MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorGuillem Muntane MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorNiall G. Campbell MD, PhD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorDavid J. Fox MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorBenjamin Brown MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorChris Skene MD, PhD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorNeil Davidson MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorValentina Leon MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorPaolo Dallaglio MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorHind Elzein MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorElena Garcia-Romero MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorJoan Antoni Gomez-Hospital MD, PhD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorAngel Cequier MD, PhD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorCorresponding Author
Andrea Di Marco MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Correspondence
Andrea Di Marco, MD, Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorIgnasi Anguera MD, PhD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorLuis Teruel MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorGuillem Muntane MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorNiall G. Campbell MD, PhD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorDavid J. Fox MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorBenjamin Brown MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorChris Skene MD, PhD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorNeil Davidson MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorValentina Leon MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorPaolo Dallaglio MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorHind Elzein MD
Department of Cardiology, University Hospital of South Manchester, Manchester, United Kingdom
Search for more papers by this authorElena Garcia-Romero MD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorJoan Antoni Gomez-Hospital MD, PhD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorAngel Cequier MD, PhD
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain
Search for more papers by this authorAbstract
Introduction
Risk stratification for ventricular arrhythmias in patients with ischemic cardiomyopathy needs to be improved. Coronary chronic total occlusions in an infarct-related artery (IRA-CTOs) have been associated with an increased arrhythmic risk. This study aimed to evaluate the association between IRA-CTOs and appropriate implantable cardioverter-defibrillator (ICD) therapies.
Methods and results
Observational cohort study that included 342 patients with ischemic cardiomyopathy, an ICD implanted for primary or secondary prevention, and a coronary angiography performed shortly before ICD implantation. The ICD was implanted for primary prevention in 163 patients (48%). IRA-CTO was found in 161 patients (47%). During a median follow-up of 33 months, 41% of patients experienced at least one appropriate ICD therapy. Patients with IRA-CTO had higher proportions of appropriate ICD therapies (57% vs. 26%, P < 0.001) and appropriate ICD shocks (40% vs. 17%, P < 0.001). At multivariate Cox regression, IRA-CTO was the only variable that consistently resulted as independent predictor of appropriate ICD therapies and shocks both in the global population of the study (HR 2.3, P < 0.001 and HR 3, P < 0.001, respectively) and when analyzing separately patients with primary or secondary prevention ICD.
Conclusions
IRA-CTO is an independent predictor of appropriate ICD therapies, including appropriate ICD shocks. This association is consistent across all the subgroups analyzed. Patients with IRA-CTO have a very high risk of appropriate ICD therapies. These findings may help improving risk stratification as well as the management of ventricular arrhythmias in patients with ischemic cardiomyopathy.
Supporting Information
| Filename | Description |
|---|---|
| jce13290-sup-0001-SuppMat.doc271.5 KB | Table 1. Interaction with time for IRA-CTO in the different Cox regression models analyzed Table 2. Analysis of confusion for IRA-CTO Table 3. Multivariate nonparsimonious models Table 4. Ventricular arrhythmias in patients with a CTO in a non-IRA, compared to patients without CTO Table 5. Baseline characteristics between primary and secondary prevention patients Table 6. Predictors of ventricular arrhythmias among patients with ICD implanted for primary prevention Table 7. Predictors of ventricular arrhythmias among patients with ICD implanted for secondary prevention Figure 1. Graphic evaluation of the proportionality assumption for IRA-CTO in Cox regression for any ventricular arrhythmia. Follow-up time expressed in days Figure 2. Graphic evaluation of the proportionality assumption for IRA-CTO in Cox regression for ICD shocks. Follow-up time expressed in days Figure 3. Graphic evaluation of the proportionality assumption for IRA-CTO in Cox regression for global mortality. Follow-up time expressed in days Figure 4. Graphic evaluation of the proportionality assumption for IRA-CTO in Cox regression for global mortality. Follow-up time expressed in days |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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