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Chronic total occlusion common in non-CABG patients with CAD
Fefer P. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2011.12.007.
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Approximately one in five non-CABG patients with significant coronary artery disease had chronic total occlusion, according to results of a study that examined the prevalence of chronic total occlusion in a contemporary catheterization laboratory practice.
Researchers identified chronic total occlusions in 1,697 (18.4%) of patients with significant CAD >50% stenosis in one or more arteries) who were undergoing nonemergent angiography from April 2008 to July 2009. All were included in the prospective Canadian Multicenter Chronic Total Occlusions Registry. Forty percent of patients had a previous history of MI, and only 26% had electrocardiographic evidence of Q waves corresponding to chronic total occlusion artery territory. More than 50% of patients with chronic total occlusion had normal left ventricular function. Half of the chronic total occlusions identified were located in the right coronary artery. Patients with chronic total occlusion were compared with 7,680 patients who were not post-CABG and underwent nonemergent coronary angiography during the same period.
Results showed that 64% of chronic total occlusions were treated medically. One-quarter of patients underwent CABG. Patients referred for CABG were less likely to have renal insufficiency, prior MI or coronary intervention compared with patients referred for medical therapy. Thirty percent of patients with chronic total occlusion underwent percutaneous coronary intervention; however, chronic total occlusion lesions were attempted in just 10% of patients, with a 70% success rate, according to the study abstract.
“The true prevalence of chronic total occlusion in the general population is unknown, as a certain proportion of patients with chronic total occlusion are asymptomatic or minimally symptomatic,” the researchers wrote.
“Despite major advances in surgical and percutaneous revascularization over the last decade, many patients with a chronic total occlusion were managed medically, with rates similar to those reported by older registries,” they concluded. “Randomized controlled trials are needed to compare medical management with revascularization of chronic total occlusion.
Disclosure: The researchers report no relevant financial disclosures.