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Observational Study
. 2015 Aug;101(15):1212-8.
doi: 10.1136/heartjnl-2014-306616. Epub 2015 Jun 15.

Current trends in patients with chronic total occlusions undergoing coronary CT angiography

Maksymilian P Opolski  1 , Bríain Ó Hartaigh  2 , Daniel S Berman  3 , Matthew J Budoff  4 , Stephan Achenbach  5 , Mouaz Al-Mallah  6 , Daniele Andreini  7 , Filippo Cademartiri  8 , Hyuk-Jae Chang  9 , Kavitha Chinnaiyan  10 , Benjamin J W Chow  11 , Martin Hadamitzky  12 , Joerg Hausleiter  13 , Gudrun Feuchtner  14 , Yong-Jin Kim  15 , Philipp A Kaufmann  16 , Jonathon Leipsic  17 , Erica Maffei  18 , Gianluca Pontone  7 , Gilbert Raff  10 , Leslee J Shaw  19 , Todd C Villines  20 , James K Min  2
Affiliations
Observational Study

Current trends in patients with chronic total occlusions undergoing coronary CT angiography

Maksymilian P Opolski et al. Heart. 2015 Aug.

Abstract

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.

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Conflict of interest statement

Competing interests JKM has served on the medical advisory boards of GE Healthcare, Arineta, Astra Zeneca and Bristol-Myers Squibb; Speakers’ Bureau of GE Healthcare; and received research support from GE Healthcare, Vital Images and Phillips Healthcare. Dr Truong received grant support from St Jude Medical, American College of Radiology Imaging Network and Duke Clinical Research Institute.

Figures

Figure 1
Figure 1
Early referral patterns (within 90 days after CT angiography) of patients with severe CAD (≥70%) with and without CTO (n=1372). Values are n (%). *p=0.02. †p<0.001. CABG, coronary artery bypass grafting; CAD, coronary artery disease; CCTA, coronary CT angiography; CTO, chronic total occlusion; NS, non-significant; PCI, percutaneous coronary intervention.
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