TY - JOUR
T1 - Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography
AU - Opolski, Maksymilian P.
AU - Gransar, Heidi
AU - Lu, Yao
AU - Achenbach, Stephan
AU - Al-Mallah, Mouaz H.
AU - Andreini, Daniele
AU - Bax, Jeroen J.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Cademartiri, Filippo
AU - Callister, Tracy Q.
AU - Chang, Hyuk Jae
AU - Chinnaiyan, Kavitha
AU - Chow, Benjamin J.W.
AU - Cury, Ricardo C.
AU - DeLago, Augustin
AU - Feuchtner, Gudrun M.
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Kaufmann, Philipp A.
AU - Kim, Yong Jin
AU - Leipsic, Jonathon A.
AU - Maffei, Erica C.
AU - Marques, Hugo
AU - Pontone, Gianluca
AU - Raff, Gilbert
AU - Rubinshtein, Ronen
AU - Shaw, Leslee J.
AU - Villines, Todd C.
AU - Gomez, Millie
AU - Jones, Erica C.
AU - Peña, Jessica M.
AU - Min, James K.
AU - Lin, Fay Y.
N1 - Funding Information:
Funding the research reported in this publication was funded, in part, by the heart, lung and Blood institute of the national institutes of health (Bethesda, Maryland, Usa) under award number r01 hl115150, and also supported, in part, by the Dalio institute of cardiovascular imaging (new York, new York, Usa) and the Michael Wolk heart Foundation (new York, new York, Usa).
Funding Information:
Competing interests Dr JKM receives funding from the Dalio Foundation, national institutes of health and ge healthcare. Dr JKM serves on the scientific advisory board of arineta and ge healthcare, and has an equity interest in cleerly. all other coauthors have no relevant disclosures.
Publisher Copyright:
© 2019 Author(s).
PY - 2019/2/1
Y1 - 2019/2/1
N2 - 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.
AB - 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.
KW - cardiac computer tomographic (ct) imaging
KW - heart disease
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U2 - 10.1136/heartjnl-2017-312907
DO - 10.1136/heartjnl-2017-312907
M3 - Article
C2 - 30061160
AN - SCOPUS:85060029651
SN - 1355-6037
VL - 105
SP - 196
EP - 203
JO - Heart
JF - Heart
IS - 3
ER -