Treatment of Patients with Chronically Occluded Coronary Arteries

BACKGROUND: Chronic total occlusions (CTOs) are a common finding in patients with coronary artery disease; however, their best management is currently debated. OBJECTIVES: The aim of this study was to assess treatment strategies in patients with CTOs and their interaction with clinical factors. METHODS: From January 2010 to December 2015, all patients in our coronary angiography database with at least one CTO were included. Patients with a history of coronary artery bypass graft (CABG) surgery or heart transplantation and patients with acute occlusions were excluded. Clinical, angiographic and treatment information was collected by review of hospital records and coronary angiograms. RESULTS: Of 15 869 patients undergoing coronary angiography from 2010– 2015, 1004 (6.3%) had at least one CTO (mean age 67.4 ± 11.7 years, 20.0% female). Of these, 899 (89.5%) were symptomatic at the time of presentation. Mean left ventricular ejection fraction (LVEF) was 49.3% ± 14.5%. The initial treatment strategy was medical therapy in 500 patients (49.8%), percutaneous coronary intervention (PCI) in 322 (32.1%), and CABG in 182 (18.1%). Clinical factors associated with medical therapy were advanced age, female gender, congestive heart failure and reduced LVEF. The presence of multivessel coronary artery disease, two or more CTOs in a single patient and a CTO in a main branch (as opposed to side branches) were associated with revascularisation (either PCI or CABG). CONCLUSION: CTOs are common findings in patients undergoing invasive coronary angiography. Despite significant improvements in revascularisation techniques, medical treatment remains the most common treatment. Clinical factors significantly influence the choice of the most appropriate treatment strategy.