Prevalence and correlated factors for chronic total occlusion in patients with coronary artery disease in Iraqi Kurdistan

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Patients with significant coronary artery disease often have at least one vessel with Chronic Total Occlusion (CTO) as demonstrated by coronary angiography. However, the prevalence and determinants of CTO differ according to ethnicity. We aimed to investigate the prevalence and determinants of CTO in the Iraqi Kurdistan population in 2015. Clinical and angiographic data were collected in consecutive patients that underwent coronary angiography at our institution between January and December 2015. Coronary artery disease (CAD) was determined as 50% diameter stenosis in one coronary artery and CTO as total coronary artery occlusion of 3-month duration. Among 260 patients diagnosed with ischemic coronary artery disease and undergone coronary angiography, 28.5% (n=74) were diagnosed to have at least one CTO vessel and 69 (26.5%) patients had a previous history of myocardial infarction. CTOs were located in the left anterior descending coronary artery in 45% of patients while in the right coronary artery in 32%. CTO patients were substantially older (61 vs 56 years; p <0.0001) and more likely to live in non-urban areas. They frequently had more hypertension, dyslipidemia, diabetes mellitus, previous myocardial revascularization, being an exsmoker, and renal dysfunction as compared to patients without CTOs. At univariate analysis, a previous history of coronary artery bypass graft (CABG) surgery was the only predictor of having a diagnosis of CTO. Patients diagnosed with CTO in Iraqi Kurdistan had several comorbidities including cardiovascular risk factors and renal dysfunction. Previous CABG was the only predictor of CTO diagnosis.