Title

Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography

Authors

Maksymilian P. Opolski, Instytut Kardiologii im. Prymasa Tysiaclecia Stefana Kardynała Wyszynskiego
Heidi Gransar, Cedars-Sinai Medical Center
Yao Lu, New York Presbyterian Hospital
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz H. Al-Mallah, King Abdullah International Medical Research Center
Daniele Andreini, Università degli Studi di Milano
Jeroen J. Bax, Leiden University Medical Center - LUMC
Daniel S. Berman, Università degli Studi di Milano
Matthew J. Budoff, Harbor-UCLA Medical Center
Filippo Cademartiri, IRCCS Fondazione SDN
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Hyuk Jae Chang, Severance Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Benjamin J.W. Chow, University of Ottawa, Canada
Ricardo C. Cury, Baptist Cardiac and Vascular Institute
Augustin DeLago, Capital Cardiology Associates
Gudrun M. Feuchtner, Medizinische Universitat Innsbruck
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Philipp A. Kaufmann, UniversitatsSpital Zurich
Yong Jin Kim, Seoul National University Hospital
Jonathon A. Leipsic, The University of British Columbia
Erica C. Maffei
Hugo Marques, Hospital da Luz
Gianluca Pontone, Università degli Studi di Milano
Gilbert Raff, William Beaumont Hospital
Ronen Rubinshtein, Technion - Israel Institute of Technology
Leslee J. Shaw, Emory University School of Medicine
Todd C. Villines, Walter Reed National Military Medical Center
Millie Gomez, New York Presbyterian Hospital
Erica C. Jones, New York Presbyterian Hospital
Jessica M. Peña, New York Presbyterian Hospital
James K. Min, New York Presbyterian Hospital

Document Type

Article

Publication Date

2-1-2019

Publication Title

Heart

Abstract

© 2019 Author(s). 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.

Volume

105

Issue

3

First Page

196

Last Page

203

DOI

10.1136/heartjnl-2017-312907

ISSN

13556037

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