TY - JOUR
T1 - Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI
AU - Godino, Cosmo
AU - Bassanelli, Giorgio
AU - Economou, Fotios I.
AU - Takagi, Kensuke
AU - Ancona, Marco
AU - Galaverna, Stefano
AU - Mangieri, Antonio
AU - Magni, Valeria
AU - Latib, Azeem
AU - Chieffo, Alaide
AU - Carlino, Mauro
AU - Montorfano, Matteo
AU - Cappelletti, Alberto
AU - Margonato, Alberto
AU - Colombo, Antonio
PY - 2013/9/30
Y1 - 2013/9/30
N2 - Background: Limited data are available on clinical outcome of patients with previously failed or not attempted chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). The aim of the study is to determine prevalence and predictors of cardiac death in patients with CTO not revascularized by PCI. Methods: Double-center study analyzing data of 1.345 consecutive patients with at least one CTO between 1998 and 2008. Of these, 847 patientswere successfully revascularized (Revascularized group) and 498 patients were not revascularized (Not revascularized group) either due to failure of CTO-PCI (n=337) or because no attempt was made (n=161). Results: At 4-year clinical follow-up,Not revascularized patients had a significantly higher rate of cardiacmortality (8.5% vs. 2.5%, p<0.0001) and sudden cardiac death (2.7% vs. 0.5%, p=0.001) compared to those Revascularized. The separate adjusted Cox-model analysis made for Not revascularized patients showed the most significant independent predictors of cardiac death were: chronic renal failure [HR (CI), 6.0 (2.66-13.80)], low-LVEF [5.7 (2.84-11.58)], insulin-dependent diabetes mellitus (IDDM) 4.6 [(1.96-10.97)]. In the Revascularized group, the presence of 3-vessel disease was the only significant independent predictor of cardiac death [4.4 (1.40-13.70)]. Conclusions: CTO patients Not revascularized had a significant higher rate of cardiacmortality and sudden cardiac death compared to those Revascularized.Within Not revascularized patients, the presence of low-LVEF, or CRF or IDDMwas associatedwith an incidence of cardiac death at least 4 times higher than those without the same risk factors.
AB - Background: Limited data are available on clinical outcome of patients with previously failed or not attempted chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). The aim of the study is to determine prevalence and predictors of cardiac death in patients with CTO not revascularized by PCI. Methods: Double-center study analyzing data of 1.345 consecutive patients with at least one CTO between 1998 and 2008. Of these, 847 patientswere successfully revascularized (Revascularized group) and 498 patients were not revascularized (Not revascularized group) either due to failure of CTO-PCI (n=337) or because no attempt was made (n=161). Results: At 4-year clinical follow-up,Not revascularized patients had a significantly higher rate of cardiacmortality (8.5% vs. 2.5%, p<0.0001) and sudden cardiac death (2.7% vs. 0.5%, p=0.001) compared to those Revascularized. The separate adjusted Cox-model analysis made for Not revascularized patients showed the most significant independent predictors of cardiac death were: chronic renal failure [HR (CI), 6.0 (2.66-13.80)], low-LVEF [5.7 (2.84-11.58)], insulin-dependent diabetes mellitus (IDDM) 4.6 [(1.96-10.97)]. In the Revascularized group, the presence of 3-vessel disease was the only significant independent predictor of cardiac death [4.4 (1.40-13.70)]. Conclusions: CTO patients Not revascularized had a significant higher rate of cardiacmortality and sudden cardiac death compared to those Revascularized.Within Not revascularized patients, the presence of low-LVEF, or CRF or IDDMwas associatedwith an incidence of cardiac death at least 4 times higher than those without the same risk factors.
KW - CTO not attempted
KW - CTO not revascularized
KW - Cardiac death
KW - Chronic total occlusion
KW - Sudden death
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U2 - 10.1016/j.ijcard.2012.12.044
DO - 10.1016/j.ijcard.2012.12.044
M3 - Article
C2 - 23317549
AN - SCOPUS:84885329349
SN - 0167-5273
VL - 168
SP - 1402
EP - 1409
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 2
ER -