The Impact of a Chronic Total Coronary Occlusion on Outcomes of Patients With an Implantable Cardioverter Defibrillator: Insights From the EXPLORE Trial.

A chronic total occlusion (CTO) may increase the risk of appropriate implantable cardioverter-defibrillator (ICD) therapy. Therefore, we evaluated all patients who received an ICD during 5-year follow-up in the EXPLORE trial. Of 22 ICD patients, twelve were randomized to CTO percutaneous coronary intervention (PCI) and 10 to no revascularizaton of the CTO. Appropriate ICD therapy occurred in 1 patient in the CTO-PCI group. Compared with the 280 non-ICD patients in the EXPLORE trial, the 22 ICD patients had higher risk of adverse cardiac events (32% vs 10%; P<.01) and death (18% vs 6%; P=.02). These results suggest that ICD patients with CTO are at risk of poor outcomes; however, their benefit from ICD implantation is questionable.