Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry

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• 作者：Mateusz Tajstra ; MD ; PhD^a ; ^{mateusztajstra@wp.pl" class="auth_mail" title="E-mail the corresponding author} ; Łukasz Pyka ; MD^a ; Jarosław Gorol ; MD^a ; Damian Pres ; MD ; PhD^a ; Marek Gierlotka ; MD ; PhD^a ; Elżbieta Gadula-Gacek ; MD^a ; Anna Kurek ; MD^a ; Michał Wasiak ; MD^a ; Michał Hawranek ; MD ; PhD^a ; Michał Oskar Zembala ; MD ; PhD^b ; Andrzej Lekston ; MD ; PhD^a ; Lech Poloński ; MD ; PhD^a ; Leszek Bryniarski ; MD ; PhD^c ; Mariusz Gąsior ; MD ; PhD^a
• 关键词：cardiomyopathy ; chronic total occlusion ; heart failure ; ischemic left ventricle dysfunction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：12 September 2016
• 年：2016
• 卷：9
• 期：17
• 页码：1790-1797
• 全文大小：739 K

文摘

This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy.

Background

The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed.

Methods

The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443). The patients were divided into 2 groups with regard to CTO presence. All of the analyzed patients were followed up for at least 12 months with all-cause mortality defined as the primary endpoint.

Results

Of the 675 patients fulfilling the inclusion and exclusion criteria, 278 patients (41.2%) had 1 or more CTOs of a major coronary artery (+CTO), and in 397 patients (58.8%) the presence of the CTO was not observed (−CTO). The 12-month mortality for the +CTO and −CTO patients was 19.4 % and 10.3 %, respectively (p < 0.001), evident also after 24 months (26.6% vs. 17.6%; p = 0.01). After a multivariate adjustment for differences in baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk: 1.84: 95% confidence interval: 1.18 to 2.85; p = 0.006).

Conclusions

Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.