Impact of the Presence of Chronic Total Occlusions on the Survival of Patients Treated with Coronary Artery Bypass Grafting
Abstract
1. Introduction
2. Patients and Methods
2.1. Study Population
2.2. Data Collection
2.3. Definition of Parameters
2.4. Definition of Primary and Secondary Outcomes
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Intraoperative Data
3.3. Early Clinical Outcomes
3.4. Follow-Up Data
4. Discussion
- (I)
- The presence of CTO was a predictor of 3-, 5-, and 10-year mortality before and after statistical adjustments. However, this effect was weaker than other investigated factors.
- (II)
- Coronary reintervention rates remained low, even after 10 years, indicating a durable treatment.
- (III)
- The treatment of CTO with CABG revealed very favorable long-term outcomes.
5. Conclusions
6. Limitations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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CTO/No CTO (Matched) | ||||
---|---|---|---|---|
Characteristics | Overall, N = 3424 * | CTO, N = 1232 * | No CTO, N = 1232 * | p-Value ** |
Matched | Matched | |||
Sex (female) | 532 (15%) | 172 (14%) | 186 (15%) | 0.4 |
Age (years) | 68.0 (62.0, 74.0) | 69.0 (63.0, 74.0) | 69.0 (63.0, 74.0) | >0.9 |
BMI (kg/m2) | 27.4 (25.1, 30.1) | 27.7 (25.4, 30.6) | 27.7 (25.4, 30.5) | 0.5 |
Diabetes | 1082 (32%) | 390 (32%) | 394 (32%) | 0.9 |
Insulin dependent Diabetes | 386 (10%) | 125 (10%) | 125 (10%) | >0.9 |
Dyslipidemia | 2728 (80%) | 1027 (83%) | 1027 (83%) | >0.9 |
Hypertension | 2844 (83%) | 1053 (85%) | 1046 (85%) | 0.7 |
Arrhythmia | 294 (8.6%) | 103 (8.4%) | 110 (8.9%) | 0.6 |
Smoking | 1172 (37%) | 469 (38%) | 436 (35%) | 0.2 |
PAD | 447 (15%) | 167 (14%) | 169 (14%) | >0.9 |
COPD | 349 (10%) | 122 (9.9%) | 113 (9.2%) | 0.5 |
History of MI | 1149 (34%) | 397 (32%) | 390 (32%) | 0.8 |
History of stroke | 209 (6.1%) | 80 (6.5%) | 62 (5.0%) | 0.12 |
Malignancy | 60 (1.9%) | 22 (1.8%) | 23 (1.9%) | 0.9 |
NYHA | 0.4 | |||
1 | 341 (11%) | 154 (13%) | 164 (13%) | |
2 | 1449 (47%) | 595 (48%) | 613 (50%) | |
3 | 1213 (39%) | 470 (38%) | 448 (36%) | |
4 | 81 (2.6%) | 13 (1.1%) | 7 (0.6%) | |
Chronic renal failure | 97 (2.9%) | 18 (1.5%) | 14 (1.1%) | 0.5 |
EuroScore II | 1.3 (0.9, 2.0) | 1.2 (0.9, 1.8) | 1.2 (0.9, 1.8) | 0.2 |
Preop. LVEF < 30% | 88 (2.8%) | 5 (0.4%) | 5 (0.4%) | >0.9 |
Significantly stenosed vessels | >0.9 | |||
1 | 24 (1%) | 1 (<0.1%) | 1 (<0.1%) | |
2 | 283 (8%) | 53 (4%) | 53 (4%) | |
3 | 3108 (91%) | 1178 (96%) | 1178 (96%) | |
CSS Classification | 0.002 | |||
CCS 0 | 258 (8.4%) | 115 (9.3%) | 90 (7.3%) | |
CCS 1 | 114 (3.7%) | 51 (4.1%) | 40 (3.3%) | |
CCS 2 | 816 (27%) | 359 (29%) | 314 (26%) | |
CCS 3 | 1244 (41%) | 514 (42%) | 531 (43%) | |
CCS 4 | 638 (21%) | 192 (16%) | 255 (21%) |
CTO Distribution | Overall, N = 3424 | CTO, N = 1232 |
---|---|---|
Matched | ||
CTO LAD | 439 (25%) | 285 (23%) |
CTO RCA | 1174 (67%) | 826 (67%) |
CTO LCX | 584 (33%) | 403 (33%) |
Revascularization of CTO LAD | 408 (92%) | 265 (93%) |
Revascularization of CTO RCA | 1001 (85%) | 702 (85%) |
Revascularization of CTO LCX | 464 (79%) | 315 (75%) |
CTO/No CTO (Matched) | ||||
---|---|---|---|---|
Characteristic | Overall, N = 3424 * | CTO, N = 1232 * | No CTO, N = 1232 * | p-Value ** |
30-day mortality | 59 (1.7%) | 18 (1.5%) | 16 (1.3%) | 0.7 |
Coronary reintervention after 30 days | 95 (2.8%) | 37 (3.0%) | 35 (2.9%) | 0.8 |
Re-CABG after 30 days | 4 (0.1%) | 1 (<0.1%) | 1 (<0.1%) | >0.9 |
PCI after 30 days | 95 (2.8%) | 37 (3.0%) | 36 (2.9%) | >0.9 |
Hospital stay (days) | 14.0 (11.0, 17.0) | 14.0 (11.0, 17.0) | 13.0 (11.0, 16.0) | <0.001 |
Length of ICU stay (days) | 1.0 (0.9, 1.9) | 0.9 (0.9, 1.8) | 0.9 (0.8, 1.6) | 0.10 |
Pacemaker implantation after 30 days | 49 (1.4%) | 18 (1.5%) | 17 (1.4%) | 0.9 |
Postoperative Dialysis | 113 (3.3%) | 26 (2.1%) | 29 (2.4%) | 0.7 |
Deep Sternal Infection | 109 (3.3%) | 45 (3.7%) | 31 (2.5%) | 0.10 |
Postoperative stroke | 73 (2.1%) | 27 (2.2%) | 21 (1.7%) | 0.4 |
Postoperative AF | 643 (19%) | 252 (20%) | 207 (17%) | 0.020 |
CTO/No CTO (Matched) | ||||
---|---|---|---|---|
Characteristic | Overall, N = 3424 * | CTO, N = 1232 * | No CTO, N = 1232 * | p-Value ** |
3-year mortality | 277 (8.1%) | 94 (7.6%) | 67 (5.4%) | 0.028 |
5-year mortality | 417 (12%) | 153 (12%) | 100 (8.1%) | <0.001 |
10-year mortality | 778 (23%) | 302 (24%) | 187 (15%) | <0.001 |
Coronary reinterventions after 3 years | 228 (6.7%) | 88 (7.2%) | 86 (7.1%) | >0.9 |
Coronary reinterventions after 5 years | 274 (8.1%) | 106 (8.7%) | 97 (8.0%) | 0.5 |
Coronary reinterventions after 10 years | 336 (9.9%) | 143 (12%) | 125 (10%) | 0.2 |
Re CABG after 3 years | 5 (0.1%) | 2 (0.2%) | 1 (<0.1%) | >0.9 |
Re CABG after 5 years | 5 (0.1%) | 2 (0.2%) | 1 (<0.1%) | >0.9 |
Re CABG after 10 years | 5 (0.1%) | 2 (0.2%) | 1 (<0.1%) | >0.9 |
PCI after 3 years | 228 (6.7%) | 88 (7.1%) | 91 (7.4%) | 0.8 |
PCI after 5 years | 274 (8.1%) | 107 (8.7%) | 102 (8.3%) | 0.7 |
PCI after 10 years | 335 (9.9%) | 138 (11%) | 116 (9.4%) | 0.14 |
Postoperative coronary angiography | 616 (18%) | 253 (21%) | 185 (15%) | <0.001 |
Multivariable Cox Regression | HR | 95%CI | p-Value |
---|---|---|---|
CTO | 1.220 | 1.047–1.420 | 0.010 |
Age | 1.055 | 1.044–1.066 | <0.001 |
Hypertension | 1.159 | 0.915–1.468 | 0.218 |
History of smoking | 1.488 | 1.270–1.743 | <0.001 |
History of malignancy | 1.647 | 0.998–2.716 | 0.050 |
NYHA IV | 1.936 | 1.051–3.567 | 0.034 |
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Fagu, A.; Kletzer, J.; Ernst, F.M.; Micek, L.; Kondov, S.; Kreibich, M.; Pingpoh, C.; Siepe, M.; Czerny, M.; Berger, T. Impact of the Presence of Chronic Total Occlusions on the Survival of Patients Treated with Coronary Artery Bypass Grafting. J. Cardiovasc. Dev. Dis. 2025, 12, 243. https://doi.org/10.3390/jcdd12070243
Fagu A, Kletzer J, Ernst FM, Micek L, Kondov S, Kreibich M, Pingpoh C, Siepe M, Czerny M, Berger T. Impact of the Presence of Chronic Total Occlusions on the Survival of Patients Treated with Coronary Artery Bypass Grafting. Journal of Cardiovascular Development and Disease. 2025; 12(7):243. https://doi.org/10.3390/jcdd12070243
Chicago/Turabian StyleFagu, Albi, Joseph Kletzer, Franziska Marie Ernst, Laurin Micek, Stoyan Kondov, Maximilian Kreibich, Clarence Pingpoh, Matthias Siepe, Martin Czerny, and Tim Berger. 2025. "Impact of the Presence of Chronic Total Occlusions on the Survival of Patients Treated with Coronary Artery Bypass Grafting" Journal of Cardiovascular Development and Disease 12, no. 7: 243. https://doi.org/10.3390/jcdd12070243
APA StyleFagu, A., Kletzer, J., Ernst, F. M., Micek, L., Kondov, S., Kreibich, M., Pingpoh, C., Siepe, M., Czerny, M., & Berger, T. (2025). Impact of the Presence of Chronic Total Occlusions on the Survival of Patients Treated with Coronary Artery Bypass Grafting. Journal of Cardiovascular Development and Disease, 12(7), 243. https://doi.org/10.3390/jcdd12070243