Abstract 604 Chronic Total Occlusion Represents an Independent Predictor of Mortality in Patients with Malignant Arrhythmia and Sudden Cardiac Death

Clin Res Cardiol 107, Suppl 1, April 2018
Chronic Total Occlusion Represents an Independent Predictor of Mortality in Patients with Malignant Arrhythmia and Sudden Cardiac Death
M. Behnes¹, K. A. Mashayekhi², P. Kuche¹, T. Schupp¹, L. Reiser¹, A. Bollow¹, G. Taton¹, T. Reichelt¹, D. Ellguth¹, N. Engelke¹, S. Lang¹, H. Neuser³, F.-J. Neumann², C. Weiß⁴, M. Borggrefe¹, I. Akin¹
¹I. Med Klinik - Kardiologie, Angiologie und Pneumologie und Intensivmedizin, Klinikum Mannheim GmbH,Universitätsklinikum, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; ²Klinik für Kardiologie und Angiologie II, Herzzentrum Bad Krozingen, Bad Krozingen; ³Klinik für Innere Medizin II, HELIOS Vogtland-Klinikum Plauen, Plauen; ⁴Universtitätsmedizin Mannheim, Institute of Biomathematics and Medical Statistic, Mannheim;
Objectives: The study sought to assess the outcome of patients with native chronic total occlusions (CTO) in patients presenting with malignant arrhythmia and sudden cardiac death (SCD). Background: Data regarding the outcome of patients with CTO presenting with malignant arrhythmia and SCD is rare. Methods: A large retrospective registry was performed including all consecutive patients presenting with ventricular tachycardia (VT), ventricular fibrillation (VF) and SCD undergoing coronary angiography from 2002 to 2016. Patients with native un-revascularized CTO (“CTO”) were compared to all other patients (“no-CTO”). The primary prognostic outcome was long-term all-cause death at 18 months (1.5 years) occurring until 2016. Results: A total of 1,543 high-risk patients were included with an overall mean follow-up of 4 years. The prevalence of native CTO was 16% (RCA 43%, LAD 19%, RCX 18%, multiple 20%). The prevalence of SCD was significantly higher in CTO compared to no-CTO (24% versus 15%, p=0.002), whereas VT and VF were evenly distributed (range of prevalence 41-47%; p>0.05). The presence of native CTO significantly impaired mortality (mortality rate 47% versus 33%; log rank p=0.001; HR = 1.606; 95% CI 1.309 – 1.971; p=0.001), irrespective of the underlying malignant arrhythmia (VT/VF), degree of LV dysfunction, single- or multi-vessel CAD or presence of an ICD. A numerically worse prognosis of RCA- and RCX-CTO compared to LAD-CTO was observed. Conclusion: The presence of native CTO represents an independent prognostic risk factor associated with increased long-term mortality in patients presenting with malignant arrhythmia and SCD.
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