PT  - JOURNAL ARTICLE
AU  - Maksymilian P Opolski
AU  - Bríain ó Hartaigh
AU  - Daniel S Berman
AU  - Matthew J Budoff
AU  - Stephan Achenbach
AU  - Mouaz Al-Mallah
AU  - Daniele Andreini
AU  - Filippo Cademartiri
AU  - Hyuk-Jae Chang
AU  - Kavitha Chinnaiyan
AU  - Benjamin J W Chow
AU  - Martin Hadamitzky
AU  - Joerg Hausleiter
AU  - Gudrun Feuchtner
AU  - Yong-Jin Kim
AU  - Philipp A Kaufmann
AU  - Jonathon Leipsic
AU  - Erica Maffei
AU  - Gianluca Pontone
AU  - Gilbert Raff
AU  - Leslee J Shaw
AU  - Todd C Villines
AU  - James K Min
TI  - Current trends in patients with chronic total occlusions undergoing coronary CT angiography
AID  - 10.1136/heartjnl-2014-306616
DP  - 2015 Aug 01
TA  - Heart
PG  - 1212--1218
VI  - 101
IP  - 15
4099  - http://heart.bmj.com/content/101/15/1212.short
4100  - http://heart.bmj.com/content/101/15/1212.full
SO  - Heart2015 Aug 01; 101
AB  - 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.