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Impact of CTO Revascularization on Sudden Cardiac Death and/or Ventricular Arrhythmias: A Meta-analysis of

Dimitrios Sfairopoulos1, George Bazoukis2,3, Haipeng Liu4

  • 1Department of Cardiology, University of Ioannina, School of Medicine, Ioannina, Greece.

Current Cardiology Reviews
|April 6, 2026
PubMed

Insights

Revascularization of chronic total occlusions (CTOs) did not significantly reduce sudden cardiac death (SCD) or ventricular arrhythmias (VAs). However, revascularizing IRA-CTOs was linked to a lower risk of SCD and VAs.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Chronic total occlusions (CTOs) are linked to increased risks of sudden cardiac death (SCD) and ventricular arrhythmias (VAs).
  • Evaluating the impact of revascularizing CTOs on these adverse cardiac events is crucial for clinical decision-making.

Purpose of the Study:

  • To systematically review and meta-analyze the existing literature on the association between CTO revascularization and the risk of SCD and/or VAs.
  • To differentiate the impact of general CTO revascularization versus IRA-CTO revascularization on SCD and VAs.

Main Methods:

  • A systematic literature review was conducted to identify relevant studies.
  • A meta-analysis was performed on data from six selected studies, encompassing 2,017 participants for the primary outcome and 868 for the secondary outcome.

Main Results:

  • Overall CTO revascularization did not show a statistically significant reduction in the risk of SCD and/or VAs (HR: 0.78; 95% CI: 0.38-1.60; P=0.50).
  • Revascularization specifically of IRA-CTOs was associated with a significant 79% lower risk of SCD and/or VAs (HR: 0.21; 95% CI: 0.10-0.43; P<0.0001).

Conclusions:

  • CTO revascularization, in general, does not appear to lower the risk of SCD and/or VAs.
  • Revascularization of IRA-CTOs demonstrates a significant benefit in reducing the risk of SCD and VAs.
  • Limitations include the observational nature of the included studies, necessitating cautious interpretation.
Abstract

Keywords:
Chronic total occlusioncoronary arteryrevascularizationsudden cardiac deathventricular arrhythmiasventricular tachycardia

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