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. 2014 Aug 12;9(8):e103850.
doi: 10.1371/journal.pone.0103850. eCollection 2014.

Chronic total occlusions in Sweden--a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Truls Råmunddal  1 , Loes P Hoebers, Jose P S Henriques  2 , Christian Dworeck  1 , Oskar Angerås  1 , Jacob Odenstedt  1 , Dan Ioanes  1 , Göran Olivecrona  3 , Jan Harnek  3 , Ulf Jensen  4 , Mikael Aasa  4 , Risto Jussila  4 , Stefan James  5 , Bo Lagerqvist  5 , Göran Matejka  1 , Per Albertsson  1 , Elmir Omerovic  1
Affiliations

Chronic total occlusions in Sweden--a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Truls Råmunddal et al. PLoS One. .

Erratum in

  • PLoS One. 2014;9(10):e112370. Hoebers, Loes [corrected to Hoebers, Loes P]

Abstract

Introduction: Evidence for the current guidelines for the treatment of patients with chronic total occlusions (CTO) in coronary arteries is limited. In this study we identified all CTO patients registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and studied the prevalence, patient characteristics and treatment decisions for CTO in Sweden.

Methods and results: Between January 2005 and January 2012, 276,931 procedures (coronary angiography or percutaneous coronary intervention) were performed in 215,836 patients registered in SCAAR. We identified all patients who had 100% luminal diameter stenosis known or assumed to be ≥ 3 months old. After exclusion of patients with previous coronary artery bypass graft (CABG) surgery or coronary occlusions due to acute coronary syndrome, we identified 16,818 CTO patients. A CTO was present in 10.9% of all coronary angiographies and in 16.0% of patients with coronary artery disease. The majority of CTO patients were treated conservatively and PCI of CTO accounted for only 5.8% of all PCI procedures. CTO patients with diabetes and multivessel disease were more likely to be referred to CABG.

Conclusion: CTO is a common finding in Swedish patients undergoing coronary angiography but the number of CTO procedures in Sweden is low. Patients with CTO are a high-risk subgroup of patients with coronary artery disease. SCAAR has the largest register of CTO patients and therefore may be valuable for studies of clinical importance of CTO and optimal treatment for CTO patients.

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Conflict of interest statement

Competing Interests: Dr Stefan James has during the last 3 years received institutional research grants from Medtronic, Terumo Inc,Vascular Solutions and served as an advisory board member for Medtronic. Dr Jose P.S. Henriques has received unrestricted research grant from Abbott Vascular. Dr Elmir Omerovic serves as an advisory board member for Astra Zeneca and has received lecturing fees from Medtronic and Astra Zeneca. All other co-authors have no disclosures or potential conflicts of interest.

Figures

Figure 1
Figure 1. Flow chart for identification and selection of CTO patients in SCAAR.
Based on the selection methods we have defined two CTO groups. The first group - the total CTO cohort- contains all CTO patients recognized by one or both methods during the period. The second group is the subcohort that contains the patients in whom a CTO was identified through the %-luminal stenosis on the coronary segments – the coronary segment subcohort.
Figure 2
Figure 2. Annual number of coronary angiographies, PCI's, and PCI's performed in CTO patients in Sweden reported in SCAAR since 1999.
Figure 3
Figure 3. Coronary location of CTO observed at angiography.
RCA = right coronary artery, LAD = left descending coronary artery, LCx = left circumflex coronary artery, LM = left main.
See this image and copyright information in PMC

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