Abstract 17557: Prevalence, Characteristics, and Early Treatment Strategies of Patients with Chronic Total Occlusions Undergoing Coronary Computed Tomography Angiography

Abstract

Introduction: Data describing the prevalence, characteristics, and management of chronic total occlusions (CTO) in patients undergoing coronary computed tomography angiography (CCTA) have not been reported. Objectives: The purpose of this study was to determine the prevalence, characteristics, and treatment strategies of CTO identified by CCTA. Methods: We identified 23,745 patients who underwent CCTA for suspected coronary artery disease (CAD) from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. Baseline clinical data were collected, and allocation to early coronary revascularization performed within 90 days of CCTA was determined. Multivariable logistic regression reporting odds ratios (OR) with 95% confidence intervals (95%CI) was performed. Results: Patients with CTO were older (64.7 ± 10.8 vs 57.2 ± 12.6 years, p<0.001) and more often male (74.6% vs 54.1%, p<0.001) compared with patients without CTO. The prevalence of CTO was 1.4% (342/23,745) in all patients and 6.2% in patients with obstructive CAD (≥50% stenosis). The presence of CTO was independently associated with male sex, smoking, hypertension, diabetes, age, and less common atypical angina (Table). Most CTO patients (61%) were treated medically, while 39% underwent coronary revascularization. In patients with severe CAD (≥70% stenosis), CTO independently predicted revascularization by CABG (OR 3.06, 95%CI: 1.88-4.98, p<0.001) but not by PCI (p=0.08). Conclusions: CTOs are not uncommon in a contemporary CCTA population and are associated with age, gender, angina status and CAD risk factors. Most individuals with CTO undergoing CCTA are managed medically with higher rates of surgical revascularization in patients with versus without CTO.