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

• Type of Material: Article
• Authors: Maksymilian P Opolski, Institute of Cardiology; Brian O Hartaigh, NewYork-Presbyterian Hospital; Daniel S Berman, Cedars Sinai Medical Center; Matthew J Budoff, Harbor UCLA Medical Center; Stephan Achenbach, University of Erlangen; Mouaz Al-Mallah, Wayne State University; Daniele Andreini, University of Milan; Filippo Cademartiri, Giovanni XXIII Hospital; Hyuk-Jae Chang, Severance Cardiovascular Hospital; Kavitha Chinnaiyan, William Beaumont Hospital; Benjamin J W Chow, University of Ottawa; Martin Hadamitzky, Deutsches Herzzentrum München; Joerg Hausleiter, University of Munich; Gudrun Feuchtner, Medical University of Innsbruck; Yong-Jin Kim, Seoul National University Hospital; Philipp A Kaufmann, University Hospital Zurich; Jonathon Leipsic, University of British Columbia; Erica Maffei, Giovanni XXIII Hospital; Gianluca Pontone, University of Milan; Gilbert Raff, William Beaumont Hospital; Leslee J Shaw, Emory University; Todd C Villines, Walter Reed National Military Medical Center; James K Min, NewYork-Presbyterian Hospital
• Language: English
• Date: 2015-08-01
• Publisher: BMJ Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2019 BMJ Publishing Group Ltd & British Cardiovascular Society. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1136/heartjnl-2014-306616
• Title of Journal or Parent Work: Bulletin. Roslyn, N. Y. St. Francis Hospital and Sanatorium for Cardiac Children
• Volume: 101
• Issue: 15
• Start Page: 1212
• End Page: 1218
• Grant/Funding Information: Research reported in this publication was supported by the Heart, Lung and Blood Institute of the National Institutes of Health (Bethesda, Maryland) under award number R01 HL115150.; MPO has received scholarship from the Foundation for Polish Science.; This research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP) (2012027176).; This study was also funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York, USA); and the Michael Wolk Heart Foundation (New York, New York, USA).; Dr Truong receives funding support from the Heart, Lung and Blood Institute of the National Institutes of Health (Bethesda, Maryland) under award numbers K23 HL098370 and L30 HL093896.
• Keywords: ARTERY-DISEASE; INTERNATIONAL MULTICENTER REGISTRY; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; CLINICAL-DIAGNOSIS; ANGIOPLASTY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; DIAGNOSTIC PERFORMANCE; Science & Technology; INTERVENTIONS; PROGNOSTIC VALUE; PREDICTION; ALL-CAUSE MORTALITY
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

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.