Ventricular arrhythmias and mortality in chronic total coronary occlusion: PCI versus optimal medical therapy in patients with LVEF greater than 35.

Background

Ventricular arrhythmia (VA) risk in patients with chronic total coronary occlusion (CTO) without advanced left ventricular (LV) dysfunction is poorly defined, and whether revascularization reduces VA compared with optimal medical therapy (OMT) remains unknown.

Methods

We conducted a single-center retrospective cohort study of 100 patients with angiographically confirmed CTO, LVEF > 35%, and no coronary artery bypass surgery after diagnosis between January 2010 and January 2019. CTO percutaneous coronary intervention (CTO-PCI) was performed in 44 patients, while 56 received OMT. Primary outcomes were VA and all-cause mortality at study end. Secondary cardiovascular outcomes were assessed. Kaplan - Meier methods were used for VA and mortality analyses, performed with STATA 15 and RStudio.

Results

Mean age was 59.9 ± 13.1 years, BMI was 31.8 ± 7.4 kg/m2, 66% were male, 64% White, and 23% Black. Baseline characteristics, including LVEF, CTO number and location, and use of antiarrhythmics, beta-blockers, and statins, were similar between groups. During 4.1 ± 2.5 years of follow-up, OMT was associated with higher VA (21.4% vs 2.3%, p = 0.01) and mortality (37.5% vs 15.9%, p = 0.03) than successful CTO-PCI.

Conclusions

Among CTO patients with LVEF > 35%, VA and mortality were frequent, particularly with OMT, supporting prospective studies to confirm benefit and refine patient selection for revascularization strategies.