Objective The aim of this study is to evaluate the long-Term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI). Methods From a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-Term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs. Results Up to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients. Conclusions At long-Term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events.

Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion / Godino, C.; Giannattasio, A.; Scotti, A.; Baldetti, L.; Pivato, C. A.; Munafo, A.; Cappelletti, A.; Beneduce, A.; Melillo, F.; Chiarito, M.; Biondi Zoccai, G.; Frati, G.; Fragasso, G.; Azzalini, L.; Carlino, M.; Montorfano, M.; Margonato, A.; Colombo, A.. - In: HEART. - ISSN 1355-6037. - 105:14(2019), pp. 1096-1102. [10.1136/heartjnl-2018-314076]

Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion

Biondi Zoccai G.;Frati G.;
2019

Abstract

Objective The aim of this study is to evaluate the long-Term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI). Methods From a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-Term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs. Results Up to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients. Conclusions At long-Term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events.
2019
coronary artery disease; coronary occlusion; percutaneous coronary intervention; sudden cardiac death; Chronic Disease; Coronary Angiography; Coronary Vessels; Female; Follow-Up Studies; Humans; Incidence; Italy; Male; Risk Factors; Time; Conservative Treatment; Coronary Artery Disease; Coronary Occlusion; Death, Sudden, Cardiac; Percutaneous Coronary Intervention
01 Pubblicazione su rivista::01a Articolo in rivista
Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion / Godino, C.; Giannattasio, A.; Scotti, A.; Baldetti, L.; Pivato, C. A.; Munafo, A.; Cappelletti, A.; Beneduce, A.; Melillo, F.; Chiarito, M.; Biondi Zoccai, G.; Frati, G.; Fragasso, G.; Azzalini, L.; Carlino, M.; Montorfano, M.; Margonato, A.; Colombo, A.. - In: HEART. - ISSN 1355-6037. - 105:14(2019), pp. 1096-1102. [10.1136/heartjnl-2018-314076]
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1474370
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 17
social impact