RT Journal Article
SR Electronic
T1 Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 196
OP 203
DO 10.1136/heartjnl-2017-312907
VO 105
IS 3
A1 Maksymilian P Opolski
A1 Heidi Gransar
A1 Yao Lu
A1 Stephan Achenbach
A1 Mouaz H Al-Mallah
A1 Daniele Andreini
A1 Jeroen J Bax
A1 Daniel S Berman
A1 Matthew J Budoff
A1 Filippo Cademartiri
A1 Tracy Q Callister
A1 Hyuk-Jae Chang
A1 Kavitha Chinnaiyan
A1 Benjamin JW Chow
A1 Ricardo C Cury
A1 Augustin DeLago
A1 Gudrun M Feuchtner
A1 Martin Hadamitzky
A1 Joerg Hausleiter
A1 Philipp A Kaufmann
A1 Yong-Jin Kim
A1 Jonathon A Leipsic
A1 Erica C Maffei
A1 Hugo Marques
A1 Gianluca Pontone
A1 Gilbert Raff
A1 Ronen Rubinshtein
A1 Leslee J Shaw
A1 Todd C Villines
A1 Millie Gomez
A1 Erica C Jones
A1 Jessica M Peña
A1 James K Min
A1 Fay Y Lin
YR 2019
UL http://heart.bmj.com/content/105/3/196.abstract
AB 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.