AI Article Synopsis
- Coronary chronic total occlusion (CTO) increases the risk of ventricular arrhythmias (VAs), which can lead to serious heart issues like ventricular tachycardia and sudden cardiac death.
- A meta-analysis reviewing nine studies with over 3000 participants found that patients with CTOs have a 2.25 times higher risk of VAs compared to those with coronary artery disease (CAD) without CTOs.
- The analysis also suggested that percutaneous coronary intervention (PCI) for CTOs significantly lowers the risk of VAs compared to patients managed with optimal medication alone, indicating the potential benefits of revascularization.
Article Abstract
Background: Coronary chronic total occlusion (CTO) can result in ischemic cardiomyopathy which may create substrate supportive of ventricular arrhythmias (VA). The purpose of this meta-analysis is to evaluate the association of CTOs with risk of ventricular arrhythmias (VAs) and to assess the utility of CTO percutaneous coronary intervention (PCI) in this setting.
Methods: A literature search was conducted for studies reporting an association between CTOs and VAs and PCI VAs among patients with CTO. VAs were defined as ventricular tachycardia, ventricular fibrillation, sudden cardiac death, and appropriate implantable cardiac defibrillator therapy. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.
Results: Nine studies with 3068 participants (1405 with CTOs and 1663 with coronary artery disease [CAD]) met inclusion criteria. CTOs were associated with significantly higher risk of VAs compared with patients with CAD without CTOs (OR 2.25, 95 % CI 1.92-2.64; p < 0.01). Three studies with 1830 patients with CTOs (970 revascularized, 860 on optimal medical therapy) met inclusion criteria for evaluating the association of CTO revascularization and VAs. CTO PCI was associated with a significantly lower risk of VAs compared with patients treated with optimal medical therapy.
Conclusions: Patients with CTOs appear to have a higher burden of VAs compared with patients with CAD without CTOs. Revascularization of CTOs was found to be associated with significant reduction in risk of VAs, however additional high-quality studies are required to further evaluate this association.
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| http://dx.doi.org/10.1016/j.carrev.2024.11.006 | DOI Listing |
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