The Canadian Multicenter Chronic Total Occlusions Registry
Paul Fefer, MD, Merril L. Knudtson, MD, Asim N. Cheema, MD, PHD, P. Diane Galbraith, BN, MSC, Azriel B. Osherov, MD,* Sergey Yalonetsky, MD,* Sharon Gannot, BS, Michelle Samuel,* Max Weisbrod,* Daniel Bierstone,* John D. Sparkes, MSC,* Graham A. Wright, PHD,* Bradley H. Strauss, MD, PHD*
Objectives: The purpose of this study was to determine the prevalence, clinical characteristics, and management of coronary chronic total occlusions (CTOs) in current practice.
Background: There is little evidence in contemporary literature concerning the prevalence, clinical characteristics, and treatment decisions regarding patients who have coronary CTOs identified during coronary angiography.
Methods: Consecutive patients undergoing nonurgent coronary angiography with CTO were prospectively identified at 3 Canadian sites from April 2008 to July 2009. Patients with previous coronary artery bypass graft surgery or presenting with acute ST-segment elevation myocardial infarction were excluded. Detailed baseline clinical, angiographic, electrocardiographic, and revascularization data were collected.
Results: Chronic total occlusions were identified in 1,697 (18.4%) patients with significant coronary artery disease (>50% stenosis in ≥1 coronary artery) who were undergoing nonemergent angiography. Previous history of myocardial infarction was documented in 40% of study patients, with electrocardiographic evidence of Q waves corresponding to the CTO artery territory in only 26% of cases. Left ventricular function was normal in >50% of patients with CTO. Half the CTOs were located in the right coronary artery. Almost half the patients with CTO were treated medically, and 25% underwent coronary artery bypass graft surgery (CTO bypassed in 88%). Percutaneous coronary intervention was done in 30% of patients, although CTO lesions were attempted in only 10% (with 70% success rate).
Conclusions: Chronic total occlusions are common in contemporary catheterization laboratory practice. Prospective studies are needed to ascertain the benefits of treatment strategies of these complex patients.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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