Contraction, collaterals and conduction in patients with a chronic total coronary occlusion

Coronary artery disease (CAD) is a frequently encountered problem worldwide, and therefore it affects the quality-of-life of many people negatively. The ultimate expression of coronary artery disease is a chronic total coronary occlusion (CTO). The presence of a CTO is associated with higher mortality, either after ST-elevation myocardial infarction (STEMI), in cardiogenic shock or in a stable setting. Clinical observations have suggested that revascularization (i.e. by percutaneous coronary intervention (PCI)) may improve survival in these patients. However, the exact (patho)physiologic effect of a CTO on the myocardium and the effect of revascularization are still unknown.
In this thesis we have investigated patients with a CTO more in-depth. We demonstrated that there is more regional recovery of cardiac function in the CTO territory in patients randomized to CTO PCI. In the past, several research groups reported that successful revascularization of a CTO leads to an improvement of survival in stable patients. Research presented in this thesis suggests that there could be an electrical stabilizing effect of CTO revascularization, both in a stable setting and after STEMI. This electrical stabilization could hypothetically lead to a better survival in these patients, by reducing the occurrence of ventricular arrhythmias (VAs) and the risk for sudden cardiac death. Therefore, we identified patients with a CTO in a large cohort of patients with an ICD over a long period of time. We found a significantly higher mortality as well as a significantly higher rate of VAs necessitating ICD therapy in the patients with a CTO.