Impact of coronary chronic total occlusion revascularization on ventricular arrhythmias and cardiac death: a systematic review and meta-analysis

This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) revascularization and the occurrence of ventricular arrhythmias (VAs) and cardiac death.

CTO is a significant problem in patients with ischemic heart disease. However, whether VAs and cardiac death could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO revascularization and the VAs.

Potential papers published from inception to July 2024 were identified through a systematic search of PubMed and Embase databases. The primary endpoint was the incidence of VAs during follow up. The VAs includes ventricular tachycardia/ventricular fibrillation or appropriate implantable cardioverter-defibrillator (ICD) therapy. Pooled risk ratios were estimated using fixed- or random-effects meta-analysis. Sensitivity analyses were conducted to assess the influence of revascularization of CTO on the pooled VAs risk.

Our meta-analysis encompassed 10 studies representing a total of 5,966 patients. Overall, our meta-analysis indicates that CTO revascularization may be associated with a reduced incidence of VAs, though this finding is not statistically significant. The unadjusted hazard ratio (HR) was 0.91 [95% confidence interval (CI): 0.40-2.06, I²=80%, p=0.82], while the adjusted HR was 0.67 (95% CI: 0.17-2.61, I²=92%, p=0.56). In the patients with ICD, CTO revascularization may significantly reduce the incidence of VAs (adjusted HR 0.42, 95%CI, 0.27-0.64, I2=1%, p< 0.01). In the infarct-related artery CTO, the revascularization may reduce the incidence of VAs (unadjusted HR 0.42, 95% CI: 0.27-0.64, I²=1%, p<0.01), this effect did not reach statistical significance after adjustment (adjusted HR 0.52, 95% CI: 0.11-2.39, I²=72%, p=0.40). Revascularization for CTO can improve all-cause mortality (adjusted HR, 0.54; 95%CI, 0.35-0.83, I2=0%, p< 0.01), but has little effect on the outcome of cardiac death (adjusted HR, 1.00; 95% CI, 1.00-1.00, I2=43%, p= 1.00).

The meta-analysis indicates that revascularization of CTO may be associated with a decreased risk of VAs in patients, and this relationship is particularly significant in patients with ICD. Further research is needed to confirm these findings.figure