Abstract 17185: Percutaneous Intervention in Chronic Total Coronary Occlusion: Impact on Ventricular Arrhythmia and Mortality Compared to Medical Therapy

Abstract

Background: The incidence of ventricular arrhythmias (VA) in patients with chronic total coronary occlusions (CTO) in the absence of advanced left ventricular dysfunction is not well described. Moreover, little is known about how revascularization may impact VA in this population compared to medical therapy alone. Methods: In this single-center retrospective cohort study from January 2010 to January 2019. We identified 100 patients with CTO on cardiac catheterization with a left ventricular ejection fraction (LVEF) >35% who did not undergo coronary artery bypass surgery following CTO diagnosis. Percutaneous revascularization was performed for 44 patients. The primary outcomes evaluated were VA and mortality rates at end of the study period. Secondarily, cardiovascular outcomes were compared between the intervention and optimal medical therapy (OMT) groups at the end of the study period. Survival analysis was performed via Kaplan Meier calculation for VA and mortality. Statistical analysis was performed using STATA 15 and R-studio. Results: Mean age was 59.91(± 13.05) and BMI was 31.8(± 7.41). Patients were 66% male, 64% White, and 23% Black. Baseline characteristics, use of antiarrhythmic therapy, baseline LVEF, and the number of CTOs and locations of CTOs were not significantly different between groups. During a median follow-up of 4.1(± 2.54) years, the OMT group experienced higher rates of VA (21.4% vs 7.7 %, p = 0.011), and mortality (37.5% vs 15.9%, p=0.031). Conclusion: CTO in the absence of severe LV systolic dysfunction (LVEF <35%) is associated with a high rate of VA and all-cause mortality, suggesting the need for further study on the impact of CTOs and their revascularization on VA and mortality in patients with LVEF >35%.