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Coronary artery disease
Original article
Current trends in patients with chronic total occlusions undergoing coronary CT angiography
  1. Maksymilian P Opolski1,
  2. Bríain ó Hartaigh2,
  3. Daniel S Berman3,
  4. Matthew J Budoff4,
  5. Stephan Achenbach5,
  6. Mouaz Al-Mallah6,
  7. Daniele Andreini7,
  8. Filippo Cademartiri8,9,
  9. Hyuk-Jae Chang10,
  10. Kavitha Chinnaiyan11,
  11. Benjamin J W Chow12,
  12. Martin Hadamitzky13,
  13. Joerg Hausleiter14,
  14. Gudrun Feuchtner15,
  15. Yong-Jin Kim16,
  16. Philipp A Kaufmann17,
  17. Jonathon Leipsic18,
  18. Erica Maffei8,
  19. Gianluca Pontone7,
  20. Gilbert Raff11,
  21. Leslee J Shaw19,
  22. Todd C Villines20,
  23. James K Min2
    1. 1Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
    2. 2Department of Radiology, The NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, USA
    3. 3Department of Imaging and Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
    4. 4Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California, USA
    5. 5Department of Medicine, University of Erlangen, Erlangen, Germany
    6. 6Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan, USA
    7. 7Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
    8. 8Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy
    9. 9Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
    10. 10Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
    11. 11Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oaks, Michigan, USA
    12. 12Department of Medicine and Radiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    13. 13Division of Cardiology, Deutsches Herzzentrum München, Munich, Germany
    14. 14Division of Cardiology, Ludwig-Maximilians-Universität München, Munich, Germany
    15. 15Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
    16. 16Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea
    17. 17Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
    18. 18Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
    19. 19Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
    20. 20Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
    1. Correspondence to Dr James K Min, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, 413 East 69th Street, New York, NY 10021, USA; jkm2001{at}med.cornell.edu

    Abstract

    Objective 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.

    Methods 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.

    Results 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).

    Conclusions 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.

    Trial registration number ClinicalTrials.gov identifier NCT01443637.

    https://doi.org/10.1136/heartjnl-2014-306616

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