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

 Maksymilian P Opolski  ;  Heidi Gransar  ;  Yao Lu  ;  Stephan Achenbach  ;  Mouaz H Al-Mallah  ;  Daniele Andreini  ;  Jeroen J Bax  ;  Daniel S Berman  ;  Matthew J Budoff  ;  Filippo Cademartiri  ;  Tracy Q Callister  ;  Hyuk-Jae Chang  ;  Kavitha Chinnaiyan  ;  Benjamin JW Chow  ;  Ricardo C Cury  ;  Augustin DeLago  ;  Gudrun M Feuchtner  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Philipp A Kaufmann  ;  Yong-Jin Kim  ;  Jonathon A Leipsic  ;  Erica C Maffei  ;  Hugo Marques  ;  Gianluca Pontone  ;  Gilbert Raff  ;  Ronen Rubinshtein  ;  Leslee J Shaw  ;  Todd C Villines  ;  Millie Gomez  ;  Erica C Jones  ;  Jessica M Peña  ;  James K Min  ;  Fay Y Lin 
 HEART, Vol.105(3) : 196-203, 2019 
Journal Title
Issue Date
cardiac computer tomographic (ct) imaging ; heart disease
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.

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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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