Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI

Cosmo Godino, Giorgio Bassanelli, Fotios I. Economou, Kensuke Takagi, Marco Ancona, Stefano Galaverna, Antonio Mangieri, Valeria Magni, Azeem Latib, Alaide Chieffo, Mauro Carlino, Matteo Montorfano, Alberto Cappelletti, Alberto Margonato, Antonio Colombo

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71 Scopus citations


Background: Limited data are available on clinical outcome of patients with previously failed or not attempted chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). The aim of the study is to determine prevalence and predictors of cardiac death in patients with CTO not revascularized by PCI. Methods: Double-center study analyzing data of 1.345 consecutive patients with at least one CTO between 1998 and 2008. Of these, 847 patientswere successfully revascularized (Revascularized group) and 498 patients were not revascularized (Not revascularized group) either due to failure of CTO-PCI (n=337) or because no attempt was made (n=161). Results: At 4-year clinical follow-up,Not revascularized patients had a significantly higher rate of cardiacmortality (8.5% vs. 2.5%, p<0.0001) and sudden cardiac death (2.7% vs. 0.5%, p=0.001) compared to those Revascularized. The separate adjusted Cox-model analysis made for Not revascularized patients showed the most significant independent predictors of cardiac death were: chronic renal failure [HR (CI), 6.0 (2.66-13.80)], low-LVEF [5.7 (2.84-11.58)], insulin-dependent diabetes mellitus (IDDM) 4.6 [(1.96-10.97)]. In the Revascularized group, the presence of 3-vessel disease was the only significant independent predictor of cardiac death [4.4 (1.40-13.70)]. Conclusions: CTO patients Not revascularized had a significant higher rate of cardiacmortality and sudden cardiac death compared to those Revascularized.Within Not revascularized patients, the presence of low-LVEF, or CRF or IDDMwas associatedwith an incidence of cardiac death at least 4 times higher than those without the same risk factors.

Original languageEnglish (US)
Pages (from-to)1402-1409
Number of pages8
JournalInternational Journal of Cardiology
Issue number2
StatePublished - Sep 30 2013
Externally publishedYes


  • CTO not attempted
  • CTO not revascularized
  • Cardiac death
  • Chronic total occlusion
  • Sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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