RT Journal Article SR Electronic T1 Current trends in patients with chronic total occlusions undergoing coronary CT angiography JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1212 OP 1218 DO 10.1136/heartjnl-2014-306616 VO 101 IS 15 A1 Maksymilian P Opolski A1 Bríain ó Hartaigh A1 Daniel S Berman A1 Matthew J Budoff A1 Stephan Achenbach A1 Mouaz Al-Mallah A1 Daniele Andreini A1 Filippo Cademartiri A1 Hyuk-Jae Chang A1 Kavitha Chinnaiyan A1 Benjamin J W Chow A1 Martin Hadamitzky A1 Joerg Hausleiter A1 Gudrun Feuchtner A1 Yong-Jin Kim A1 Philipp A Kaufmann A1 Jonathon Leipsic A1 Erica Maffei A1 Gianluca Pontone A1 Gilbert Raff A1 Leslee J Shaw A1 Todd C Villines A1 James K Min YR 2015 UL http://heart.bmj.com/content/101/15/1212.abstract 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.