Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography

Opolski MP, Gransar H, Lu Y, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, Delago A, Feuchtner GM, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei EC, Marques H, Pontone G, Raff G, Rubinshtein R, Shaw LJ, Villines TC, Gomez M, Jones EC, Pena JM, Min JK, Lin FY (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 105

Pages Range: 196-203

Journal Issue: 3

DOI: 10.1136/heartjnl-2017-312907

Abstract

Objective Data describing clinical relevance of chronic total occlusion (CTO) identified by coronary CT angiography (CCTA) have not been reported to date. We investigated the prognosis of CTO on CCTA. Methods We identified 22 828 patients without prior known coronary artery disease (CAD), who were followed for a median of 26 months. Based on CCTA, coronary lesions were graded as normal (no atherosclerosis), non-obstructive (1%-49%), moderate-to-severe (50%-99%) or totally occluded (100%). All-cause mortality, and major adverse cardiac events defined as mortality, non-fatal myocardial infarction and late coronary revascularisation (>= 90 days after CCTA) were assessed. Results The distribution of patients with normal coronaries, non-obstructive CAD, moderate-to-severe CAD and CTO was 10 034 (44%), 7965 (34.9%), 4598 (20.1%) and 231 (1%), respectively. The mortality rate per 1000 person-years of CTO patients was non-significantly different from patients with moderate-to-severe CAD (22.95; 95% CI 12.71 to 41.45 vs 14.46; 95% CI 12.34 to 16.94; p=0.163), and significantly higher than of those with normal coronaries and non-obstructive CAD (p<0.001 for both). Among 14 382 individuals with follow-up for the composite end point, patients with CTO had a higher rate of events than those with moderate-to-severe CAD (106.56; 95% CI 76.51 to 148.42 vs 65.45; 95% CI 58.01 to 73.84, p=0.009). This difference was primarily driven by an increase in late revascularisations in CTO patients (27 of 35 events). After multivariable adjustment, compared with individuals with normal coronaries, the presence of CTO conferred the highest risk for adverse cardiac events (14.54; 95% CI 9.11 to 23.20, p<0.001). Conclusions The detection of CTO on non-invasive CCTA is associated with increased rate of late revascularisation but similar 2-year mortality as compared with moderate-to-severe CA

Authors with CRIS profile

Involved external institutions

Tennessee Heart & Vascular United States (USA) (US) University of Ottawa Canada (CA) New York Presbyterian Hospital United States (USA) (US) Università degli studi di Milano Italy (IT) Baptist Health South Florida United States (USA) (US) Technion - Israel Institute of Technology Israel (IL) Cedars-Sinai Medical Center United States (USA) (US) Walter Reed Army Medical Center (WRAMC) United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Hospital da Luz Portugal (PT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Deutsches Herzzentrum München Germany (DE) Institute of Cardiology in Warsaw Poland (PL) Yonsei University Korea, Republic of (KR) Emory University United States (USA) (US) Leiden University Netherlands (NL) Ludwig-Maximilians-Universität (LMU) Germany (DE) University of California Los Angeles (UCLA) United States (USA) (US) King Abdulaziz Cardiac Center Saudi Arabia (SA) University of British Columbia Canada (CA) Beaumont Health System United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH)

How to cite

APA:

Opolski, M.P., Gransar, H., Lu, Y., Achenbach, S., Al-Mallah, M.H., Andreini, D.,... Lin, F.Y. (2019). Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography. Heart, 105(3), 196-203. https://dx.doi.org/10.1136/heartjnl-2017-312907

MLA:

Opolski, Maksymilian P., et al. "Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography." Heart 105.3 (2019): 196-203.

BibTeX: Download