title: Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice.
abstract: BACKGROUND
  Chronic total coronary occlusions (CTOs) represent a subgroup of coronary lesions with a low procedural success and high recurrence rate. However, there is evidence for a prognostic benefit of revascularizing a CTO.
  
  
  OBJECTIVE
  This study assessed the prevalence of CTOs among patients with stable angina pectoris and its impact on therapeutic strategies.
  
  
  METHODS
  Between 2001 and 2003, a survey was conducted in 64 sites to analyze the outcome of the first diagnostic angiography in patients presenting with stable angina pectoris (STAR registry). The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed.
  
  
  RESULTS
  A total of 2,002 patients were entered into the registry. One-third had at least one CTO. At 1 year, the mortality in patients with a CTO was significantly higher than in those without a CTO (5.5 vs. 3.1%; P = 0.009). This excess mortality was related to a higher prevalence of confounding factors in patients with a CTO such as diabetes and more severe LV dysfunction. Patients with a CTO were more likely to undergo surgery or being treated medically, whereas patients without a CTO were more likely to undergo PCI. If a CTO was treated by PCI the periprocedural and long-term outcome was similar to those with PCI for a non-occlusive lesion. However, periprocedural MACE was higher for patients treated for a non-occlusive lesion without first treating the CTO.
  
  
  CONCLUSIONS
  The prevalence of CTOs in patients with stable angina pectoris is high, and it influences the clinical outcome within the first year. The therapeutic strategy is influenced towards a rather conservative approach and lower rates of interventional therapy.
authors.affiliation: Medizinische Klinik I, Klinikum Darmstadt, Darmstadt, Germany. gerald.werner@klinikum-darmstadt.de
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Claus
authors.initials: C
authors.lastname: Juenger
authors.forename: Frank
authors.initials: F
authors.lastname: Towae
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications*; D017115:Catheter Ablation; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome