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 Opolski, Maksymilian P
A1 Gransar, Heidi
A1 Lu, Yao
A1 Achenbach, Stephan
A1 Al-Mallah, Mouaz H
A1 Andreini, Daniele
A1 Bax, Jeroen J
A1 Berman, Daniel S
A1 Budoff, Matthew J
A1 Cademartiri, Filippo
A1 Callister, Tracy Q
A1 Chang, Hyuk-Jae
A1 Chinnaiyan, Kavitha
A1 Chow, Benjamin JW
A1 Cury, Ricardo C
A1 DeLago, Augustin
A1 Feuchtner, Gudrun M
A1 Hadamitzky, Martin
A1 Hausleiter, Joerg
A1 Kaufmann, Philipp A
A1 Kim, Yong-Jin
A1 Leipsic, Jonathon A
A1 Maffei, Erica C
A1 Marques, Hugo
A1 Pontone, Gianluca
A1 Raff, Gilbert
A1 Rubinshtein, Ronen
A1 Shaw, Leslee J
A1 Villines, Todd C
A1 Gomez, Millie
A1 Jones, Erica C
A1 Peña, Jessica M
A1 Min, James K
A1 Lin, Fay Y
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.