TY - JOUR T1 - Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography JF - Heart JO - Heart SP - 196 LP - 203 DO - 10.1136/heartjnl-2017-312907 VL - 105 IS - 3 AU - Maksymilian P Opolski AU - Heidi Gransar AU - Yao Lu AU - Stephan Achenbach AU - Mouaz H Al-Mallah AU - Daniele Andreini AU - Jeroen J Bax AU - Daniel S Berman AU - Matthew J Budoff AU - Filippo Cademartiri AU - Tracy Q Callister AU - Hyuk-Jae Chang AU - Kavitha Chinnaiyan AU - Benjamin JW Chow AU - Ricardo C Cury AU - Augustin DeLago AU - Gudrun M Feuchtner AU - Martin Hadamitzky AU - Joerg Hausleiter AU - Philipp A Kaufmann AU - Yong-Jin Kim AU - Jonathon A Leipsic AU - Erica C Maffei AU - Hugo Marques AU - Gianluca Pontone AU - Gilbert Raff AU - Ronen Rubinshtein AU - Leslee J Shaw AU - Todd C Villines AU - Millie Gomez AU - Erica C Jones AU - Jessica M Peña AU - James K Min AU - Fay Y Lin Y1 - 2019/02/01 UR - http://heart.bmj.com/content/105/3/196.abstract N2 - 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 CAD.Trial registration number NCT01443637. ER -