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Clinical Profile of Patients With Chronically Occluded Coronary Arteries: A Single Center Study
Vikrant Deshmukh1, Mukund Vasantrao Phutane1, Kalyan Munde1
1Department of Cardiology, The Grant Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India.
Insights
Chronic total occlusions (CTOs) in coronary arteries predominantly affect males over 40, with hypertension and diabetes being strong risk factors. The right coronary artery is most commonly affected.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Chronic total occlusions (CTOs) represent a significant challenge in interventional cardiology, affecting up to one-third of patients undergoing coronary angiography.
- These complex lesions, defined by a complete interruption of coronary flow (TIMI-0) for over 3 months, are often undertreated due to technical difficulties.
- Understanding the clinical profile and natural history of CTO patients is crucial for optimizing treatment strategies.
Purpose of the Study:
- To delineate the clinical characteristics and demographic profile of patients presenting with coronary artery chronic total occlusions (CTOs).
- To investigate the prevalence of various risk factors, comorbidities, and previous interventions in patients with CTOs.
- To identify the most commonly affected coronary arteries and the typical clinical presentations associated with CTOs.
Main Methods:
- An observational study was conducted at a tertiary health center in Mumbai, involving 117 patients with angiographically confirmed CTOs.
- Clinical presentations and angiographic findings were meticulously correlated and analyzed.
- Data collected included patient demographics, risk factors (smoking, tobacco, alcohol), comorbidities (diabetes, hypertension, dyslipidemia), prior cardiac history (MI, CABG, PCI), and the extent of coronary artery disease.
Main Results:
- The study included 117 patients, with a predominance of males (73.50%) and individuals over 40 years old, particularly in the 60-69 age group (36.75%).
- Hypertension (66.67%) and diabetes (53.84%) were highly prevalent comorbidities, with 41.88% having both. Tobacco use (38.46%) was more common than smoking (27.35%).
- Unstable angina/NSTEMI (53.84%) was the most frequent presentation, followed by chronic stable angina. The right coronary artery (RCA) was the most affected artery (52.14%), followed by the left anterior descending artery (LAD) (34.18%).
Conclusions:
- Coronary artery CTOs primarily affect individuals over 40, with a higher incidence in males and the 60-69 age bracket.
- Hypertension, diabetes, and tobacco use are significant associated risk factors for CTO development.
- RCA CTO is most common, and patients frequently present with acute coronary syndromes like unstable angina/NSTEMI, highlighting the need for effective management strategies.
Background:
A chronic total occlusion (CTO) is defined as an angiographically documented or clinically suspected complete interruption of antegrade coronary flow (Thrombolysis in Myocardial Infarction (TIMI)-0 flow) of greater than 3 months standing. Coronary CTOs represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques. Decision to treat or not to treat a CTO is always confusing. This is an attempt to provide clinical profile of patients having totally occluded coronary arteries and their natural history.
Methods:
The observational study was carried out in tertiary health center in Mumbai. Totally 117 patients who had CTO on angiography were selected. Their clinical presentation and angiography correlation was done and results were analyzed.
Results:
Out of a total of 117 patients, 86 (73.50 %) were males, female 31(26%). All of the patients studied were above 40 years. Age group 40 - 49 years had 25 (21.36%) patients, 50 - 59 years had 32 (27.35%), 60 - 69 years had 43 (36.75%), > 70 years had 17 (14.52%) patients. Smoking as a risk factor was present in 32 (27.35%), tobacco in 45 (38.46%), alcohol in six (5%), no addictions in 35 (29.91%) patients. Diabetes in 63 (53.84%), hypertension in 78 (66.67%) patients, both were present in 49 (41.88%), dyslipidemia in 37 (31.62%) patients. Sixty-three (53.84 %) patients presented with unstable angina (UA)/non ST elevated myocardial infarction (NSTEMI), 32 (27.35%) with chronic stable angina (CSA), ST elevated myocardial infarction (STEMI) in 22 (18.80%). History of prior myocardial infarction (MI) was present in 36 (30.76%), prior coronary artery bypass graft (CABG) in nine (7.6%), prior percutaneous intervention (PCI) in 18 (15.38%). Triple vessel disease (TVD) in 38 (32.47%), double vessel disease (DVD) in 53 (45.29%), single vessel disease (SVD) in 26 (22.22%) patients. Left anterior descending artery (LAD) CTO was present in 40 (34.18%), right coronary artery (RCA) in 61 (52.14%), left circumflex artery (LCX) obtuse marginal (OM) in 16 (13.67%) patients.
Conclusions:
Patients having CTO of coronary arteries are mostly above age of 40 years. Most common age group was 60 - 69 years. It was most common in males than females. Tobacco chewing was more commonly associated followed by smoking. Hypertension and diabetes were strongly associated with CTO. Most patients presented with unstable angina/NSTEMI followed by chronic stable angina. Old MI was present in one third of patients. Most common artery to be affected was RCA followed by LAD.
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