Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion

Cosmo Godino, Alessia Giannattasio, Andrea Scotti, Luca Baldetti, Carlo Andrea Pivato, Andrea Munafò, Alberto Cappelletti, Alessandro Beneduce, Francesco Melillo, Mauro Chiarito, Giuseppe Biondi Zoccai, Giacomo Frati, Gabriele Fragasso, Lorenzo Azzalini, Mauro Carlino, Matteo Montorfano, Alberto Margonato, Antonio Colombo

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18 Scopus citations


Objective The aim of this study is to evaluate the long-Term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI). Methods From a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-Term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs. Results Up to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients. Conclusions At long-Term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events.

Original languageEnglish
Pages (from-to)1096-1102
Number of pages7
Issue number14
StatePublished - 1 Jul 2019
Externally publishedYes


  • coronary artery disease
  • coronary occlusion
  • percutaneous coronary intervention
  • sudden cardiac death


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