Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors

• Published in: Netherlands heart journal Vol. 29; no. 10; pp. 500 - 505
• Main Authors: van der Graaf, M., Jewbali, L. S. D., Lemkes, J. S., Spoormans, E. M., van der Ent, M., Meuwissen, M., Blans, M. J., van der Harst, P., Henriques, J. P., Beishuizen, A., Camaro, C., Bleeker, G. B., van Royen, N., Yap, S. C.
• Format: Journal Article
• Language: English
• Published: Houten Bohn Stafleu van Loghum 01-10-2021; Springer Nature B.V
• Subjects: Angioplasty; Cardiac arrest; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Confidence intervals; Coronary vessels; Defibrillators; Disease prevention; Ejection fraction; Electrocardiography; Heart attacks; Hospitalization; Hospitals; Medical Education; Medical imaging; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Population; Regression analysis; Statistical analysis; Survival analysis; Variables; Vein & artery diseases; Out-of-hospital cardiac arrest; Ventricular tachycardia; Chronic total occlusion; Implantable cardioverter-defibrillator
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-021-01578-3

Introduction
Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation.
Methods
We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death.
Results
A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank
p
 = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results.
Conclusion
In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.