BackgroundChronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort.Methods and ResultsThis is a subanalysis of the nationwide Dutch‐Outcome in ICD Therapy (DO‐IT) registry of primary prevention ICD recipients in The Netherlands between September 2014 and June 2016 (n=1442). We identified patients with chronic ischemic heart disease (n=663) and assessed available coronary angiograms for CTO presence (n=415). Patients with revascularized CTOs were excluded (n=79). The primary end point was the composite of all‐cause mortality and appropriate ICD shocks. Clinical follow‐up was conducted for at least 2 years. A total of 336 patients were included, with an average age of 67±9 years, and 20.5% was female (n=69). An unrevascularized CTO was identified in 110 patients (32.7%). During a median follow‐up period of 27 months (interquartile range, 24–32), the primary end point occurred in 21.1% of patients with CTO (n=23) compared with 11.9% in patients without CTO (n=27; P=0.034). Corrected for baseline characteristics including left ventricular ejection fraction, and the presence of a CTO was an independent predictor for the primary end point (hazard ratio, 1.82 [95% CI, 1.03–3.22]; P=0.038).ConclusionsWithin this nationwide prospective registry of primary prevention ICD recipients, the presence of an unrevascularized CTO was an independent predictor for the composite outcome of all‐cause mortality and appropriate ICD shocks.

中文翻译：

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慢性冠状动脉完全闭塞对适当植入式心脏复律除颤器休克发生率和死亡率的影响：荷兰 ICD 治疗 (DO-IT) 登记结果的子研究

背景慢性冠状动脉完全闭塞（CTO）大大增加心源性猝死的风险。对于有心源性猝死风险的慢性缺血性心脏病患者，植入式心律转复除颤器 (ICD) 是心源性猝死一级预防的首选治疗方法。本研究旨在调查全国前瞻性队列中 CTO 对适当 ICD 电击和死亡率风险的影响。方法和结果这是对全国一级预防 ICD 接受者荷兰 ICD 治疗结果 (DO-IT) 登记的亚分析2014 年 9 月至 2016 年 6 月期间在荷兰 (n=1442)。我们确定了患有慢性缺血性心脏病的患者 (n=663)，并评估了可用的冠状动脉血管造影是否存在 CTO (n=415)。接受血运重建的 CTO 患者被排除在外 (n=79)。主要终点是全因死亡率和适当的 ICD 电击的复合终点。临床随访至少2年。共纳入 336 名患者，平均年龄 67±9 岁，其中 20.5% 为女性（n=69）。在 110 名患者 (32.7%) 中发现了未进行血运重建的 CTO。在中位随访时间为 27 个月（四分位距，24-32）期间，主要终点发生在 21.1% 的 CTO 患者 (n=23) 中，而无 CTO 的患者 (n=27) 中这一比例为 11.9%；P =0.034）。对包括左心室射血分数在内的基线特征进行校正，并且 CTO 的存在是主要终点的独立预测因素（风险比，1.82 [95% CI，1.03–3.22]；P = 0.038）。结论在这个全国性前瞻性登记中在一级预防 ICD 接受者中，未进行血运重建的 CTO 的存在是全因死亡率和适当 ICD 电击复合结果的独立预测因素。