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

Journal article

Publication Details

Author(s): 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
Journal: Heart
Publication year: 2019
Volume: 105
Journal issue: 3
Pages range: 196-203
ISSN: 1355-6037


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

FAU Authors / FAU Editors

Achenbach, Stephan Prof. Dr. med.
Lehrstuhl für Innere Medizin II

External institutions with authors

Baptist Health South Florida
Beaumont Health System
Capitol Cardiology Associates
Cedars-Sinai Medical Center
Deutsches Herzzentrum München
Emory University
Hospital da Luz
Institute of Cardiology in Warsaw
King Abdulaziz Cardiac Center
Leiden University
Ludwig-Maximilians-Universität (LMU)
Medizinische Universität Innsbruck
New York Presbyterian Hospital
Seoul National University (SNU) / 서울대학교
Technion - Israel Institute of Technology
Tennessee Heart & Vascular
Università degli studi di Milano
Universitätsspital Zürich (USZ)
University of British Columbia
University of California Los Angeles (UCLA)
University of Ottawa
Walter Reed Army Medical Center (WRAMC)
Yonsei University

How to cite

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.

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


Last updated on 2019-20-03 at 12:53