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Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography.
Opolski, Maksymilian P; Gransar, Heidi; Lu, Yao; Achenbach, Stephan; Al-Mallah, Mouaz H; Andreini, Daniele; Bax, Jeroen J; Berman, Daniel S; Budoff, Matthew J; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin Jw; Cury, Ricardo C; DeLago, Augustin; Feuchtner, Gudrun M; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp A; Kim, Yong-Jin; Leipsic, Jonathon A; Maffei, Erica C; Marques, Hugo; Pontone, Gianluca; Raff, Gilbert; Rubinshtein, Ronen; Shaw, Leslee J; Villines, Todd C; Gomez, Millie; Jones, Erica C; Peña, Jessica M; Min, James K; Lin, Fay Y.
Afiliación
  • Opolski MP; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
  • Gransar H; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA.
  • Lu Y; Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
  • Achenbach S; Department of Medicine, University of Erlangen, Erlangen, Germany.
  • Al-Mallah MH; King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Riyadh, Saudi Arabia.
  • Andreini D; Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
  • Bax JJ; Department of Cardiology, Leiden University Medical Center, HARTZ, Leiden, The Netherlands.
  • Berman DS; Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
  • Budoff MJ; Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California, USA.
  • Cademartiri F; Department of Radiology, SDN IRCCS Cardiovascular Imaging Center, Naples, Italy.
  • Callister TQ; Tennessee Heart and Vascular Institute, Hendersonville, Tennessee, USA.
  • Chang HJ; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
  • Chinnaiyan K; Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan, USA.
  • Chow BJ; Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada.
  • Cury RC; Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA.
  • DeLago A; Capital Cardiology Associates, Albany, New York, USA.
  • Feuchtner GM; Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
  • Hadamitzky M; Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
  • Hausleiter J; Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
  • Kaufmann PA; University Hospital, Zurich, Switzerland.
  • Kim YJ; Seoul National University Hospital, Seoul, Republic of Korea.
  • Leipsic JA; Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
  • Maffei EC; Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.
  • Marques H; UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal.
  • Pontone G; Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
  • Raff G; Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan, USA.
  • Rubinshtein R; Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
  • Shaw LJ; Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Villines TC; Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
  • Gomez M; Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
  • Jones EC; Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
  • Peña JM; Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
  • Min JK; Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
  • Lin FY; Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA.
Heart ; 105(3): 196-203, 2019 02.
Article en En | MEDLINE | ID: mdl-30061160
OBJECTIVE: Data describing clinical relevance of chronic total occlusion (CTO) identified by coronary CT angiography (CCTA) have not been reported to date. We investigated the prognosis of CTO on CCTA. METHODS: We identified 22 828 patients without prior known coronary artery disease (CAD), who were followed for a median of 26 months. Based on CCTA, coronary lesions were graded as normal (no atherosclerosis), non-obstructive (1%-49%), moderate-to-severe (50%-99%) or totally occluded (100%). All-cause mortality, and major adverse cardiac events defined as mortality, non-fatal myocardial infarction and late coronary revascularisation (≥90 days after CCTA) were assessed. RESULTS: The distribution of patients with normal coronaries, non-obstructive CAD, moderate-to-severe CAD and CTO was 10 034 (44%), 7965 (34.9%), 4598 (20.1%) and 231 (1%), respectively. The mortality rate per 1000 person-years of CTO patients was non-significantly different from patients with moderate-to-severe CAD (22.95; 95% CI 12.71 to 41.45 vs 14.46; 95% CI 12.34 to 16.94; p=0.163), and significantly higher than of those with normal coronaries and non-obstructive CAD (p<0.001 for both). Among 14 382 individuals with follow-up for the composite end point, patients with CTO had a higher rate of events than those with moderate-to-severe CAD (106.56; 95% CI 76.51 to 148.42 vs 65.45; 95% CI 58.01 to 73.84, p=0.009). This difference was primarily driven by an increase in late revascularisations in CTO patients (27 of 35 events). After multivariable adjustment, compared with individuals with normal coronaries, the presence of CTO conferred the highest risk for adverse cardiac events (14.54; 95% CI 9.11 to 23.20, p<0.001). CONCLUSIONS: The detection of CTO on non-invasive CCTA is associated with increased rate of late revascularisation but similar 2-year mortality as compared with moderate-to-severe CAD. TRIAL REGISTRATION NUMBER: NCT01443637.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Angiografía Coronaria / Vasos Coronarios / Oclusión Coronaria / Angiografía por Tomografía Computarizada / Infarto del Miocardio / Revascularización Miocárdica Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Heart Asunto de la revista: CARDIOLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Angiografía Coronaria / Vasos Coronarios / Oclusión Coronaria / Angiografía por Tomografía Computarizada / Infarto del Miocardio / Revascularización Miocárdica Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Heart Asunto de la revista: CARDIOLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Reino Unido