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Exploring the relationship between chronic total occlusions and mortality in coronary artery disease
Joakim Sundström1, Mohammed Mohammed1, Antros Louca1
1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
The number and location of chronic total occlusions (CTOs) in coronary artery disease significantly impact long-term survival. More CTOs and specific locations like the RCA increase mortality risk, aiding in risk stratification.
Area of Science:
- Cardiology
- Vascular Biology
- Public Health
Background:
- Chronic total occlusions (CTOs) are prevalent in coronary artery disease (CAD).
- CTOs are known to affect survival, particularly in acute myocardial infarction and cardiac arrest.
- The long-term survival impact of CTOs in the broader CAD population requires further investigation.
Purpose of the Study:
- To investigate the association between the number, location, and severity of CTOs and long-term survival.
- To analyze long-term survival in a large, unselected cohort of patients with CAD.
Main Methods:
- Utilized data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) from July 2015 to December 2021.
- Excluded patients with prior coronary artery bypass grafting (CABG).
- Categorized patients by CTO count (none, 1, ≥2) and location (LAD, LCX, RCA); assessed survival using Kaplan-Meier and Cox models.
Main Results:
- Out of 202,191 patients, 88.0% had no CTO, 9.8% had 1 CTO, and 2.1% had ≥2 CTOs.
- Survival decreased with an increasing number of CTOs (p < 0.0001).
- Hazard ratios for mortality were 1.69 for 1 CTO and 2.27 for ≥2 CTOs compared to no CTOs; adjusted HRs for LAD, RCA, and LCX were 1.31, 1.59, and 1.28, respectively.
Conclusions:
- The presence, quantity, and anatomical position of CTOs are significant determinants of long-term survival in CAD patients.
- Findings support long-term risk stratification for patients with CTOs.
- This information can potentially enhance patient selection for revascularization interventions.
Background:
Chronic total occlusions (CTOs) are common in coronary artery disease (CAD) and are known to impact survival, especially in acute myocardial infarction and cardiac arrest. However, their impact on long-term survival across the broader population with CAD remains less studied. We studied the association between the number, location, and severity of CTOs and long-term survival in a large, unselected cohort.
Methods:
Patients undergoing coronary angiography in Sweden between July 2015 and December 2021 were identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Individuals with prior CABG were excluded. Patients were categorized by the number of CTOs (none, 1, or ≥ 2) and location (LAD, LCX, or RCA). Survival was assessed using Kaplan-Meier and Cox proportional hazards models.
Results:
Of 202,191 patients, 88.0 % had no CTO, 9.8 % had 1 CTO, and 2.1 % had ≥2 CTOs. Survival worsened with increasing CTOs (p < 0.0001). Compared to no CTO, hazard ratios were 1.69 (95 % CI, 1.63-1.76; p < 0.001) for 1 CTO and 2.27 (95 % CI, 2.13-2.42; p < 0.001) for ≥2 CTOs. Adjusted HRs by location were 1.31 (95 % CI, 1.24-1.38; p < 0.001) for LAD, 1.59 (95 % CI, 1.52-1.66; p < 0.001) for RCA, and 1.28 (95 % CI, 1.21-1.35; p < 0.001) for LCX.
Conclusions:
The presence, number, and location of CTOs significantly influence long-term survival. This provides long-term risk stratification for patients with CTO, which may improve patient selection for interventions.
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