Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting
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1Michigan Heart Group, Troy 48083.
Insights
Approximately one third of patients undergoing coronary arteriography have totally occluded coronary arteries. About half of these occlusions show features favorable for successful coronary angioplasty, indicating potential for revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Totally occluded coronary arteries (TOCAs) present a significant challenge in revascularization strategies.
- Assessing the frequency and angioplasty suitability of TOCAs is crucial for patient management.
Purpose of the Study:
- To determine the incidence of TOCAs in an unselected patient cohort.
- To evaluate the angiographic characteristics of TOCAs for suitability for percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective review of coronary angiograms from a community hospital over one year.
- Inclusion criteria: > or = 50% diameter stenosis.
- Analysis of morphological variables to predict successful revascularization.
Main Results:
- 112 TOCAs were identified in 101 patients (35% of eligible patients).
- 46% (52 TOCAs) were deemed suitable for coronary angioplasty based on morphology.
- Unfavorable TOCA morphology for angioplasty occurred in 29% of patients with multivessel CAD, more often in the right coronary artery.
Conclusions:
- TOCAs are prevalent, found in about one-third of patients undergoing coronary arteriography.
- Nearly half of TOCAs possess favorable features for successful coronary angioplasty.
- These findings highlight the potential for interventional treatment in a substantial proportion of TOCA patients.
Abstract:
To assess the frequency of totally occluded coronary arteries and their angiographic suitability for catheter-based revascularization in an unselected patient population, all coronary angiograms showing > or = 50% diameter stenosis obtained from patients in a community hospital setting, were reviewed during a 1-year period. There were 112 totally occluded arteries in 101 patients (35%). Based on coronary morphologic variables previously identified as predictive of successful revascularization, 52 (46%) totally occluded arteries were judged suitable for coronary angioplasty. Totally occluded arteries with unfavorable features for coronary angioplasty were present in 29% of patients with multivessel coronary artery disease and were more commonly present in the right coronary artery. Thus totally occluded coronary arteries are found in approximately one third of patients with suspected or known coronary artery disease studied by means of coronary arteriography in a community hospital setting. Approximately one half of the total occlusions have features favoring successful coronary angioplasty.