Current trends in patients with chronic total occlusions undergoing coronary CT angiography

Opolski MP, Hartaigh BO, Berman DS, Budoff MJ, Achenbach S, Al-Mallah M, Andreini D, Cademartiri F, Chang HJ, Chinnaiyan K, Chow BJW, Hadamitzky M, Hausleiter J, Feuchtner G, Kim YJ, Kaufmann PA, Leipsic J, Maffei E, Pontone G, Raff G, Shaw LJ, Villines TC, Min JK (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Book Volume: 101

Pages Range: 1212-8

Journal Issue: 15

DOI: 10.1136/heartjnl-2014-306616

Abstract

Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment strategies of CTO identified by CCTA.We identified 23 745 patients who underwent CCTA for suspected coronary artery disease (CAD) from the prospective international CCTA registry. Baseline clinical data were collected, and allocation to early coronary revascularisation performed within 90 days of CCTA was determined. Multivariable hierarchical mixed-effects logistic regression reporting OR with 95% CI was performed.The prevalence of CTO was 1.4% (342/23 745) in all patients and 6.2% in patients with obstructive CAD (>=50% stenosis). The presence of CTO was independently associated with male sex (OR 3.12, 95% CI 2.39 to 4.08, p<0.001), smoking (OR 2.02, 95% CI 1.55 to 2.64, p<0.001), diabetes (OR 1.60, 95% CI 1.22 to 2.11, p=0.001), typical angina (OR 1.51, 95% CI 1.12 to 2.06, p=0.008), hypertension (OR 1.47, 95% CI 1.14 to 1.88, p=0.003), family history of CAD (OR 1.30, 95% CI 1.01 to 1.67, p=0.04) and age (OR 1.06, 95% CI 1.05 to 1.07, p<0.001). Most patients with CTO (61%) were treated medically, while 39% underwent coronary revascularisation. In patients with severe CAD (>=70% stenosis), CTO independently predicted revascularisation by coronary artery bypass grafting (OR 3.41, 95% CI 2.06 to 5.66, p<0.001), but not by percutaneous coronary intervention (p=0.83).CTOs are not uncommon in a contemporary CCTA population, and are associated with age, gender, angina status and CAD risk factors. Most individuals with CTO undergoing CCTA are managed medically with higher rates of surgical revascularisation in patients with versus without CTO.ClinicalTrials.gov identifier NCT01443637.

Authors with CRIS profile

Involved external institutions

Harbor–UCLA Medical Center United States (USA) (US) Institute of Cardiology in Warsaw Poland (PL) New York Presbyterian Hospital United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Wayne State University (WSU) United States (USA) (US) Università degli studi di Milano Italy (IT) Casa di Cura Giovanni XXIII Italy (IT) Yonsei University Health System (YUHS) Korea, Republic of (KR) Beaumont Health System United States (USA) (US) University of Ottawa Canada (CA) Deutsches Herzzentrum München Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Medizinische Universität Innsbruck Austria (AT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Universitätsspital Zürich (USZ) Switzerland (CH) University of British Columbia Canada (CA) Emory University United States (USA) (US) Walter Reed Army Medical Center (WRAMC) United States (USA) (US)

How to cite

APA:

Opolski, M.P., Hartaigh, B.O., Berman, D.S., Budoff, M.J., Achenbach, S., Al-Mallah, M.,... Min, J.K. (2015). Current trends in patients with chronic total occlusions undergoing coronary CT angiography. Heart, 101(15), 1212-8. https://doi.org/10.1136/heartjnl-2014-306616

MLA:

Opolski, Maksymilian P., et al. "Current trends in patients with chronic total occlusions undergoing coronary CT angiography." Heart 101.15 (2015): 1212-8.

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