Association of revascularization with risk of ventricular arrhythmias in patients with chronic total occlusion of coronary arteries: Systematic review and meta-analysis

Abstract

Background

Coronary chronic total occlusion (CTO) can result in ischemic cardiomyopathy which may create substrate supportive of ventricular arrhythmias (VA). The purpose of this meta-analysis is to evaluate the association of CTOs with risk of ventricular arrhythmias (VAs) and to assess the utility of CTO percutaneous coronary intervention (PCI) in this setting.

Methods

A literature search was conducted for studies reporting an association between CTOs and VAs and PCI VAs among patients with CTO. VAs were defined as ventricular tachycardia, ventricular fibrillation, sudden cardiac death, and appropriate implantable cardiac defibrillator therapy. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results

Nine studies with 3068 participants (1405 with CTOs and 1663 with coronary artery disease [CAD]) met inclusion criteria. CTOs were associated with significantly higher risk of VAs compared with patients with CAD without CTOs (OR 2.25, 95 % CI 1.92–2.64; p < 0.01). Three studies with 1830 patients with CTOs (970 revascularized, 860 on optimal medical therapy) met inclusion criteria for evaluating the association of CTO revascularization and VAs. CTO PCI was associated with a significantly lower risk of VAs compared with patients treated with optimal medical therapy.

Conclusions

Patients with CTOs appear to have a higher burden of VAs compared with patients with CAD without CTOs. Revascularization of CTOs was found to be associated with significant reduction in risk of VAs, however additional high-quality studies are required to further evaluate this association.