Author + information
- Received April 5, 2018
- Revision received June 3, 2018
- Accepted June 7, 2018
- Published online July 25, 2018.
- Wai Kin Chi, MBChB, MRCPa,b,∗,
- Mengqi Gong, MSc,∗,
- George Bazoukis, MDd,
- Bryan P. Yan, MBBSa,
- Konstantinos P. Letsas, MDd,
- Tong Liu, MD, PhDc,
- Adrian Baranchuk, MDe,
- Luis Nombela-Franco, MD, PhDf,
- Mei Dong, MD, PhDg,∗ (, )
- Gary Tse, MPH, PhDa,b,
- International Health Informatics Study (IHIS) Network
- aDepartment of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
- bLi Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
- cTianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- dSecond Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
- eDepartment of Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
- fCardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- gDepartment of Cardiology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong Province, China
- ↵∗Address for correspondence:
Dr. Mei Dong, Department of Cardiology, Yantai Yuhuangding Hospital Affiliated to Qingdao 10 University, Yantai, Shandong Province, People’s Republic of China, 264000.
Objectives This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) status and the occurrence of ventricular tachycardia/fibrillation (VT/VF) or appropriate implantable cardioverter-defibrillator (ICD) therapy.
Background CTO is a significant problem in patients with ischemic heart disease. However, the extent to which it predisposes affected individuals to VT/VF and whether these arrhythmic events could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO status and the occurrence of VT/VF or appropriate ICD therapy.
Methods PubMed and Embase databases were searched until November 16, 2017, identifying 137 studies.
Results Seventeen studies involving 54,594 subjects (mean age, 61 ± 21 years of age, 81% male) with a mean follow-up of 43 ± 31 months were included. The presence of CTO was associated with higher risk of VT/VF or appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to 2.59; p < 0.0001, I2 = 3%) but not in cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18, I2 = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14; I2 = 64%). Compared to patients with non–infarct-related CTOs, those with infarct-related CTOs have a higher risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I2 = 14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05; I2 = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I2 = 40%). Nonrevascularization of CTOs tended to be associated with an increased risk of all-cause mortality compared to successful revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08; I2 = 76).
Conclusions CTOs, especially infarct-related, are associated with high risk of VT/VF or appropriate ICD therapy and mortality. ICD implantation could be beneficial. However, it is not clear that revascularization has an impact on the outcome of patients with CTOs.
↵∗ Drs. Chi and Gong contributed equally to this work and are joint first authors.
Dr. Tse is supported by a Clinical Assistant Professorship from the Croucher Foundation of Hong Kong. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 5, 2018.
- Revision received June 3, 2018.
- Accepted June 7, 2018.
- 2018 American College of Cardiology Foundation
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