Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry

Abstract

Objectives: This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy.

Background: The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed.

Methods: The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443). The patients were divided into 2 groups with regard to CTO presence. All of the analyzed patients were followed up for at least 12 months with all-cause mortality defined as the primary endpoint.

Results: Of the 675 patients fulfilling the inclusion and exclusion criteria, 278 patients (41.2%) had 1 or more CTOs of a major coronary artery (+CTO), and in 397 patients (58.8%) the presence of the CTO was not observed (-CTO). The 12-month mortality for the +CTO and -CTO patients was 19.4 % and 10.3 %, respectively (p < 0.001), evident also after 24 months (26.6% vs. 17.6%; p = 0.01). After a multivariate adjustment for differences in baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk: 1.84: 95% confidence interval: 1.18 to 2.85; p = 0.006).

Conclusions: Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.

Keywords: cardiomyopathy; chronic total occlusion; heart failure; ischemic left ventricle dysfunction.