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 KaufmannYong-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

Research output: Contribution to journalArticle

Abstract

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.

TRIAL REGISTRATION NUMBER: NCT01443637.

Original languageEnglish
Pages (from-to)196-203
Number of pages8
JournalHeart
Volume105
Issue number3
DOIs
Publication statusPublished - Feb 2019

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Coronary Artery Disease
Angiography
Coronary Angiography
Mortality
Atherosclerosis
Myocardial Infarction
Computed Tomography Angiography

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Opolski, M. P., Gransar, H., Lu, Y., Achenbach, S., Al-Mallah, M. H., Andreini, D., ... Lin, F. Y. (2019). Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography. Heart, 105(3), 196-203. https://doi.org/10.1136/heartjnl-2017-312907

Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography. / Opolski, Maksymilian P; Gransar, Heidi; Lu, Yao; Achenbach, Stephan; Al-Mallah, Mouaz H; Andreini, Daniele; Bax, Jeroen J; Berman, Daniel S; Budoff, Matthew J; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin Jw; Cury, Ricardo C; DeLago, Augustin; Feuchtner, Gudrun M; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp A; Kim, Yong-Jin; Leipsic, Jonathon A; Maffei, Erica C; Marques, Hugo; Pontone, Gianluca; Raff, Gilbert; Rubinshtein, Ronen; Shaw, Leslee J; Villines, Todd C; Gomez, Millie; Jones, Erica C; Peña, Jessica M; Min, James K; Lin, Fay Y.

In: Heart, Vol. 105, No. 3, 02.2019, p. 196-203.

Research output: Contribution to journalArticle

Opolski, MP, Gransar, H, Lu, Y, Achenbach, S, Al-Mallah, MH, Andreini, D, Bax, JJ, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, H-J, Chinnaiyan, K, Chow, BJ, Cury, RC, DeLago, A, Feuchtner, GM, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Kim, Y-J, Leipsic, JA, Maffei, EC, Marques, H, Pontone, G, Raff, G, Rubinshtein, R, Shaw, LJ, Villines, TC, Gomez, M, Jones, EC, Peña, JM, Min, JK & Lin, FY 2019, 'Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography', Heart, vol. 105, no. 3, pp. 196-203. https://doi.org/10.1136/heartjnl-2017-312907
Opolski, Maksymilian P ; Gransar, Heidi ; Lu, Yao ; Achenbach, Stephan ; Al-Mallah, Mouaz H ; Andreini, Daniele ; Bax, Jeroen J ; Berman, Daniel S ; Budoff, Matthew J ; Cademartiri, Filippo ; Callister, Tracy Q ; Chang, Hyuk-Jae ; Chinnaiyan, Kavitha ; Chow, Benjamin Jw ; Cury, Ricardo C ; DeLago, Augustin ; Feuchtner, Gudrun M ; Hadamitzky, Martin ; Hausleiter, Joerg ; Kaufmann, Philipp A ; Kim, Yong-Jin ; Leipsic, Jonathon A ; Maffei, Erica C ; Marques, Hugo ; Pontone, Gianluca ; Raff, Gilbert ; Rubinshtein, Ronen ; Shaw, Leslee J ; Villines, Todd C ; Gomez, Millie ; Jones, Erica C ; Peña, Jessica M ; Min, James K ; Lin, Fay Y. / Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography. In: Heart. 2019 ; Vol. 105, No. 3. pp. 196-203.
@article{eb643b15162943a5b27732b706cf05d0,
title = "Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography",
abstract = "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.TRIAL REGISTRATION NUMBER: NCT01443637.",
author = "Opolski, {Maksymilian P} and Heidi Gransar and Yao Lu and Stephan Achenbach and Al-Mallah, {Mouaz H} and Daniele Andreini and Bax, {Jeroen J} and Berman, {Daniel S} and Budoff, {Matthew J} and Filippo Cademartiri and Callister, {Tracy Q} and Hyuk-Jae Chang and Kavitha Chinnaiyan and Chow, {Benjamin Jw} and Cury, {Ricardo C} and Augustin DeLago and Feuchtner, {Gudrun M} and Martin Hadamitzky and Joerg Hausleiter and Kaufmann, {Philipp A} and Yong-Jin Kim and Leipsic, {Jonathon A} and Maffei, {Erica C} and Hugo Marques and Gianluca Pontone and Gilbert Raff and Ronen Rubinshtein and Shaw, {Leslee J} and Villines, {Todd C} and Millie Gomez and Jones, {Erica C} and Pe{\~n}a, {Jessica M} and Min, {James K} and Lin, {Fay Y}",
note = "{\circledC} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
month = "2",
doi = "10.1136/heartjnl-2017-312907",
language = "English",
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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 Jw

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 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/2

Y1 - 2019/2

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.TRIAL REGISTRATION NUMBER: NCT01443637.

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.TRIAL REGISTRATION NUMBER: NCT01443637.

U2 - 10.1136/heartjnl-2017-312907

DO - 10.1136/heartjnl-2017-312907

M3 - Article

C2 - 30061160

VL - 105

SP - 196

EP - 203

JO - Heart

JF - Heart

SN - 1355-6037

IS - 3

ER -