TY - JOUR
T1 - Effect of myocardial scar size on the risk of ventricular arrhythmias in patients with chronic total coronary occlusion
AU - Assaf, Amira
AU - van der Graaf, Marisa
AU - van Boven, Nick
AU - van Ettinger, Maarten J.B.
AU - Diletti, Roberto
AU - Hoogendijk, Mark G.
AU - Szili-Torok, Tamas
AU - Theuns, Dominic A.M.J.
AU - Yap, Sing Chien
N1 - Publisher Copyright: © 2023
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: The presence of an untreated chronic total coronary occlusion (CTO) is associated with a higher risk of ventricular arrhythmias (VAs). This increased risk may be modulated by the presence of an existing scar. Objectives: To evaluate whether scar size is associated with VA in patients with an implantable cardioverter-defibrillator (ICD) and a CTO. Methods: In this retrospective study we included patients with a CTO that received an ICD between 2005 and 2015. Scar size was estimated using the Selvester QRS score on a baseline 12‑lead ECG. The primary endpoint was any appropriate ICD therapy. Results: Our study population comprised 148 CTO patients with a median scar size at baseline of 18% (IQR, 9–27%). Patients with a scar size ≥18% more often had a CTO located in the left anterior descending artery and a higher proportion of poor left ventricular function (<35%) and infarct-related CTO compared to patients with a smaller scar size (<18%). During a median follow-up of 35 months (interquartile range [IQR], 8–60 months), 42 patients (28%) received appropriate ICD therapy. The cumulative 5-year event rate was higher in the patients with a large scar in comparison to those with a smaller or no scar (36% versus 19%, P = 0.04). Multivariable Cox regression analysis demonstrated that large scar and diabetes mellitus were independent factors associated with appropriate ICD therapy. Conclusion: In ICD recipients with an untreated CTO, a larger scar is an independent factor associated with an increased risk of VA.
AB - Background: The presence of an untreated chronic total coronary occlusion (CTO) is associated with a higher risk of ventricular arrhythmias (VAs). This increased risk may be modulated by the presence of an existing scar. Objectives: To evaluate whether scar size is associated with VA in patients with an implantable cardioverter-defibrillator (ICD) and a CTO. Methods: In this retrospective study we included patients with a CTO that received an ICD between 2005 and 2015. Scar size was estimated using the Selvester QRS score on a baseline 12‑lead ECG. The primary endpoint was any appropriate ICD therapy. Results: Our study population comprised 148 CTO patients with a median scar size at baseline of 18% (IQR, 9–27%). Patients with a scar size ≥18% more often had a CTO located in the left anterior descending artery and a higher proportion of poor left ventricular function (<35%) and infarct-related CTO compared to patients with a smaller scar size (<18%). During a median follow-up of 35 months (interquartile range [IQR], 8–60 months), 42 patients (28%) received appropriate ICD therapy. The cumulative 5-year event rate was higher in the patients with a large scar in comparison to those with a smaller or no scar (36% versus 19%, P = 0.04). Multivariable Cox regression analysis demonstrated that large scar and diabetes mellitus were independent factors associated with appropriate ICD therapy. Conclusion: In ICD recipients with an untreated CTO, a larger scar is an independent factor associated with an increased risk of VA.
UR - http://www.scopus.com/inward/record.url?scp=85166105687&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2023.131205
DO - 10.1016/j.ijcard.2023.131205
M3 - Article
C2 - 37482094
AN - SCOPUS:85166105687
SN - 0167-5273
VL - 390
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 131205
ER -