Prognostic impact of chronic total coronary occlusion on long-term outcomes in implantable cardioverter-defibrillator recipients with ischaemic heart disease

Aims The prognostic impact of chronic total coronary occlusion (CTO) on implantable cardioverterdefibrillator (ICD) recipients remains unclear.
Methods and Results Eighty-four consecutive patients with ischemic heart disease who received ICD therapy for primary or secondary prevention were analyzed. We investigated all-cause mortality and major adverse cardiac events (MACEs) including cardiac death, appropriate device therapy, hospitalization for heart failure, and ventricular assist device implantation. Of the study patients (mean age 70 ± 8 years; 86% men), 34 (40%) had CTO. There were no significant differences in age, left ventricular ejection fraction (LVEF), NYHA functional class III or IV status, and proportion who underwent secondary prevention between patients with CTO (CTO group) and without CTO (non-CTO group). During a median follow-up of 3.8 years (interquartile range 2.7 to 5.4 years), the CTO group tended to have a higher MACE rate (log-rank P=0.054) than the non-CTO group. Within the CTO group, there was no difference in the MACE rate between patients with and without viable myocardium. In patients with ICD for secondary prevention (n=47), 16 patients (34%) with CTO had a higher MACE rate than patients without CTO (logrank P<0.01). Cox proportional hazards regression analysis showed that the presence of CTO, but 3 not LVEF, was associated with a higher MACE rate. Multivariate analysis showed that the presence of CTO was a predictor of MACE (P<0.05).
Conclusion In patients with ischemic heart disease receiving ICD implantation, the presence of CTO has an adverse impact on long-term prognosis, especially as secondary prevention.

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内容要旨・審査要旨 : LID201701261001.pdf
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著者の申請により要約(2017-01-26公開)に替えて論文全文を公開(2018-06-15)
本論文は, 著者Tatsuya Nishikawaの学位論文として提出され, 学位審査・授与の対象となっている。