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. 2014 Oct 1;84(4):637-43.
doi: 10.1002/ccd.25264. Epub 2013 Nov 13.

Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital

Omar M Jeroudi  1 , Mohammed E Alomar, Tesfaldet T Michael, Abdallah El Sabbagh, Vishal G Patel, Owen Mogabgab, Eric Fuh, Daniel Sherbet, Nathan Lo, Michele Roesle, Bavana V Rangan, Shuaib M Abdullah, Jeffrey L Hastings, Jerrold Grodin, Subhash Banerjee, Emmanouil S Brilakis
Affiliations

Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital

Omar M Jeroudi et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: We sought to determine the contemporary prevalence and management of coronary chronic total occlusions (CTO) in a veteran population.

Background: The prevalence and management of CTOs in various populations has received limited study.

Methods: We collected clinical and angiographic data in consecutive patients that underwent coronary angiography at our institution between January 2011 and December 2012. Coronary artery disease (CAD) was defined as ≥50% diameter stenosis in ≥1 coronary artery. CTO was defined as total coronary artery occlusion of ≥3 month duration.

Results: Among 1,699 patients who underwent angiography during the study period, 20% did not have CAD, 20% had CAD and prior coronary artery bypass graft surgery (CABG), and 60% had CAD but no prior CABG. The prevalence of CTO among CAD patients with and without prior CABG was 89 and 31%, respectively. Compared to patients without CTO, CTO patients had more co-morbidities, more extensive CAD and were more frequently referred for CABG. Percutaneous coronary intervention (PCI) to any vessel was performed with similar frequency in patients with and without CTO (50% vs. 53%). CTO PCI was performed in 30% of patients without and 15% of patients with prior CABG with high technical (82 and 75%, respectively) and procedural success rates (80 and 73%, respectively).

Conclusions: In a contemporary veteran population, coronary CTOs are highly prevalent and are associated with more extensive co-morbidities and higher likelihood for CABG referral. PCI was equally likely to be performed in patients with and without CTO.

Keywords: coronary artery disease; coronary occlusion; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Patients Presenting for Diagnostic Angiography Prevalence of coronary artery disease and coronary chronic total occlusions in the study population. CABG=coronary artery bypass graft; CAD=coronary artery disease; CTO=chronic total occlusion
Figure 2
Figure 2
Distribution of CTOs in patients with one CTO Distribution of coronary chronic total occlusions among the study patients. CTO=chronic total occlusion; LAD=left anterior descending artery; LCx=left circumflex artery; OM=obtuse marginal artery; PAV=posterior atrio-ventricular vessel; PDA=posterior descending artery; PL=posterolateral; RCA=right coronary artery
Figure 3
Figure 3
Revascularization Strategy in non-CABG patients Flow chart depicting coronary revascularization strategies for patients with coronary chronic total occlusion(s) who did not have prior coronary artery bypass graft surgery. CABG=coronary artery bypass graft; CTO=chronic total occlusion; PCI=percutaneous coronary intervention
Figure 4
Figure 4
Revascularization Strategy in prior CABG patients Flow chart depicting coronary revascularization strategies for patients with coronary chronic total occlusion(s) who had prior coronary artery bypass graft surgery. CABG=coronary artery bypass graft; CTO=chronic total occlusion; PCI=percutaneous coronary intervention
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