Maksymilian P Opolski1, Bríain Ó Hartaigh2, Daniel S Berman3, Matthew J Budoff4, Stephan Achenbach5, Mouaz Al-Mallah6, Daniele Andreini7, Filippo Cademartiri8, Hyuk-Jae Chang9, Kavitha Chinnaiyan10, Benjamin J W Chow11, Martin Hadamitzky12, Joerg Hausleiter13, Gudrun Feuchtner14, Yong-Jin Kim15, Philipp A Kaufmann16, Jonathon Leipsic17, Erica Maffei18, Gianluca Pontone7, Gilbert Raff10, Leslee J Shaw19, Todd C Villines20, James K Min2. 1. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 2. Department of Radiology, The NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York, USA. 3. Department of Imaging and Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 4. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California, USA. 5. Department of Medicine, University of Erlangen, Erlangen, Germany. 6. Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan, USA. 7. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy. 8. Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 9. Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea. 10. Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oaks, Michigan, USA. 11. Department of Medicine and Radiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 12. Division of Cardiology, Deutsches Herzzentrum München, Munich, Germany. 13. Division of Cardiology, Ludwig-Maximilians-Universität München, Munich, Germany. 14. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 15. Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea. 16. Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland. 17. Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 18. Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy. 19. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. 20. Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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