Impact of Chronic Total Occlusions and Coronary Revascularization on All-Cause Mortality and the Incidence of Ventricular Arrhythmias in Patients With Ischemic Cardiomyopathy
Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical cha...
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| Veröffentlicht in: | The American journal of cardiology 2015-11, Vol.116 (9), p.1358-1362 |
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| creator | Raja, Vijay, MD Wiegn, Phi, MD Obel, Owen, MD Christakopoulos, Georgios, MD Christopoulos, George, MD Rangan, Bavana V., BDS, MPH Roesle, Michele, RN, BSN Abdullah, Shuaib M., MD Luna, Michael, MD Addo, Tayo, MD Ayers, Colby, MS Garcia, Santiago, MD de Lemos, James A., MD Banerjee, Subhash, MD Brilakis, Emmanouil S., MD, PhD |
| description | Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort. |
| doi_str_mv | 10.1016/j.amjcard.2015.07.057 |
| format | Article |
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We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2015.07.057</identifier><identifier>PMID: 26341182</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Arrhythmias, Cardiac - etiology ; Arrhythmias, Cardiac - therapy ; Cardiac arrhythmia ; Cardiology ; Cardiomyopathies - complications ; Cardiovascular ; Coronary Occlusion - diagnostic imaging ; Coronary Occlusion - etiology ; Coronary Occlusion - mortality ; Coronary Occlusion - therapy ; Defibrillators, Implantable ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Incidence ; Male ; Middle Aged ; Mortality ; Myocardial Ischemia - complications ; Radiography ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tachycardia, Ventricular - etiology ; Tachycardia, Ventricular - mortality ; Tachycardia, Ventricular - therapy ; Treatment Outcome ; United States - epidemiology</subject><ispartof>The American journal of cardiology, 2015-11, Vol.116 (9), p.1358-1362</ispartof><rights>2015</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Nov 1, 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-bfd6149ae017f51ea149a01613f24e55df32fee9a0c4a7446f0142833b1085d43</citedby><cites>FETCH-LOGICAL-c481t-bfd6149ae017f51ea149a01613f24e55df32fee9a0c4a7446f0142833b1085d43</cites><orcidid>0000-0002-9029-879X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1722479771?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26341182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raja, Vijay, MD</creatorcontrib><creatorcontrib>Wiegn, Phi, MD</creatorcontrib><creatorcontrib>Obel, Owen, MD</creatorcontrib><creatorcontrib>Christakopoulos, Georgios, MD</creatorcontrib><creatorcontrib>Christopoulos, George, MD</creatorcontrib><creatorcontrib>Rangan, Bavana V., BDS, MPH</creatorcontrib><creatorcontrib>Roesle, Michele, RN, BSN</creatorcontrib><creatorcontrib>Abdullah, Shuaib M., MD</creatorcontrib><creatorcontrib>Luna, Michael, MD</creatorcontrib><creatorcontrib>Addo, Tayo, MD</creatorcontrib><creatorcontrib>Ayers, Colby, MS</creatorcontrib><creatorcontrib>Garcia, Santiago, MD</creatorcontrib><creatorcontrib>de Lemos, James A., MD</creatorcontrib><creatorcontrib>Banerjee, Subhash, MD</creatorcontrib><creatorcontrib>Brilakis, Emmanouil S., MD, PhD</creatorcontrib><title>Impact of Chronic Total Occlusions and Coronary Revascularization on All-Cause Mortality and the Incidence of Ventricular Arrhythmias in Patients With Ischemic Cardiomyopathy</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. 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Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26341182</pmid><doi>10.1016/j.amjcard.2015.07.057</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-9029-879X</orcidid></addata></record> |
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| subjects | Aged Arrhythmias, Cardiac - etiology Arrhythmias, Cardiac - therapy Cardiac arrhythmia Cardiology Cardiomyopathies - complications Cardiovascular Coronary Occlusion - diagnostic imaging Coronary Occlusion - etiology Coronary Occlusion - mortality Coronary Occlusion - therapy Defibrillators, Implantable Female Follow-Up Studies Heart attacks Humans Incidence Male Middle Aged Mortality Myocardial Ischemia - complications Radiography Retrospective Studies Risk Factors Survival Rate Tachycardia, Ventricular - etiology Tachycardia, Ventricular - mortality Tachycardia, Ventricular - therapy Treatment Outcome United States - epidemiology |
| title | Impact of Chronic Total Occlusions and Coronary Revascularization on All-Cause Mortality and the Incidence of Ventricular Arrhythmias in Patients With Ischemic Cardiomyopathy |
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