Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion

5 years ago

Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion

A chronic total occlusion (CTO) is common in out-of-hospital cardiac arrest (OHCA) survivors with coronary artery disease. It is unclear whether a CTO contributes to ventricular arrhythmias in this population.

Objective

This study sought to evaluate the impact of unrevascularized CTO’s on the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy and all-cause mortality in OHCA survivors with coronary artery disease.

Methods

This was a retrospective study that included all consecutive OHCA survivors with coronary artery disease who received an ICD from 1999 until 2015. Study endpoints were appropriate ICD therapy and all-cause mortality.

Results

We identified 217 OHCA survivors (mean age 63±10 years, 86% man) with coronary artery disease. An unrevascularized CTO was present in 71 of 217 patients (33%) at the time of ICD implantation. During a median follow-up of 61 months (interquartile range, 28-97 months), 57 of 217 patients (26%) experienced an appropriate ICD therapy. CTO patients had a higher incidence of appropriate ICD therapy in comparison to non-CTO patients (logrank P=0.002). Multivariate Cox regression analysis identified CTO (hazard ratio, 2.07; 95% confidence interval, 1.23-3.50; P=0.007) as an independent predictor of appropriate ICD therapy. The presence of a CTO was not associated with a higher mortality rate (logrank P=0.18).

Conclusions

In OHCA survivors with coronary artery disease receiving an ICD for secondary prevention, a CTO was an independent predictor for the occurrence of ventricular arrhythmias but not for mortality.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117310834