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

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.

Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Figures

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

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

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

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