{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:38:58Z","timestamp":1783521538247,"version":"3.55.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,4,16]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This is a subanalysis of the nationwide Dutch\u2010Outcome in ICD Therapy (DO\u2010IT) registry of primary prevention ICD recipients in The Netherlands between September 2014 and June 2016 (n=1442). We identified patients with chronic ischemic heart disease (n=663) and assessed available coronary angiograms for CTO presence (n=415). Patients with revascularized CTOs were excluded (n=79). The primary end point was the composite of all\u2010cause mortality and appropriate ICD shocks. Clinical follow\u2010up was conducted for at least 2\u2009years. A total of 336 patients were included, with an average age of 67\u00b19\u2009years, and 20.5% was female (n=69). An unrevascularized CTO was identified in 110 patients (32.7%). During a median follow\u2010up period of 27\u2009months (interquartile range, 24\u201332), the primary end point occurred in 21.1% of patients with CTO (n=23) compared with 11.9% in patients without CTO (n=27;\n              <jats:italic>P<\/jats:italic>\n              =0.034). Corrected for baseline characteristics including left ventricular ejection fraction, and the presence of a CTO was an independent predictor for the primary end point (hazard ratio, 1.82 [95% CI, 1.03\u20133.22];\n              <jats:italic>P<\/jats:italic>\n              =0.038).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Within this nationwide prospective registry of primary prevention ICD recipients, the presence of an unrevascularized CTO was an independent predictor for the composite outcome of all\u2010cause mortality and appropriate ICD shocks.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032033","type":"journal-article","created":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T09:41:52Z","timestamp":1712655712000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of a Chronic Total Coronary Occlusion on the Incidence of Appropriate Implantable Cardioverter\u2010Defibrillator Shocks and Mortality: A Substudy of the Dutch Outcome in ICD Therapy (DO\u2010IT)) Registry"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3638-3261","authenticated-orcid":false,"given":"Anna","family":"van Veelen","sequence":"first","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4340-6815","authenticated-orcid":false,"given":"Tom E.","family":"Verstraelen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2585-9631","authenticated-orcid":false,"given":"Yvemarie B. O.","family":"Somsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00eblle","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo M.","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Paul H. 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A.","family":"Boersma","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"},{"name":"Department of Cardiology St. Antonius Hospital Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7936-360X","authenticated-orcid":false,"given":"Alexander H.","family":"Maass","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0360-0187","authenticated-orcid":false,"given":"Sipke","family":"Strikwerda","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amphia Hospitals Breda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4553-1502","authenticated-orcid":false,"given":"Mehran","family":"Firouzi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Maasstad Hospital Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0506-9512","authenticated-orcid":false,"given":"Cornelis P.","family":"Allaart","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-5964","authenticated-orcid":false,"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Cardiology Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+) Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-3581","authenticated-orcid":false,"given":"Robert W.","family":"Grauss","sequence":"additional","affiliation":[{"name":"Department of Cardiology Haaglanden Medical Center The Hague The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7735-1250","authenticated-orcid":false,"given":"Raymond","family":"Tukkie","sequence":"additional","affiliation":[{"name":"Department of Cardiology Spaarne Gasthuis Haarlem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8038-7898","authenticated-orcid":false,"given":"Paul","family":"Knaapen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aeilko H.","family":"Zwinderman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science Amsterdam UMC, Location AMC, University of Amsterdam Amsterdam The Netherlands"},{"name":"Methodology Amsterdam Public Health Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0750-8790","authenticated-orcid":false,"given":"Marcel G. 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