title: Influence of chronic total occlusions on coronary artery bypass graft surgical outcomes.
abstract: BACKGROUND
  Presence of epicardial coronary artery chronic total occlusion (CTO) predicts higher referral rates for coronary bypass graft surgery (CABG). However, the impact of coronary artery CTO on CABG outcomes has never been systematically studied.
  
  
  METHODS
  We examined one-year outcomes in 605 consecutive Veterans, discharged post-CABG between June 2005 and December 2008.
  
  
  RESULTS
  A coronary CTO was present in 256 patients (42%), predominantly (48.3%) in the right coronary artery distribution. Baseline clinical characteristics and medical therapy were similar in patients with and without a coronary CTO. A single CTO was present in 73.8%, and 26.2% patients had multiple CTO. All left anterior descending coronary artery CTO were successfully bypassed, as were >92% in left circumflex and right coronary arteries and 85% CTO in multiple coronary artery distributions. During the mean follow-up of 348.9 ± 4.5 days, incidence of all-cause death and myocardial infarction were similar in both groups (7.1% in CTO group and 7.4% in non-CTO group; p = 0.97). CTO >20 mm in length constituted 74.9% and >40 mm 37.8%. One-year survival post-CABG was significantly lower in patients with CTO lengths >40 mm compared to ≤20 mm (p = 0.04). CTO >40 mm was an independent predictor of post-CABG mortality controlling for age, number of CTO, comorbid diseases, clopidogrel use, severity of coronary artery disease, renal failure, and left ventricular ejection fraction.
  
  
  CONCLUSIONS
  CABG achieves high success in grafting epicardial coronary vessels with CTO; however, presence of long coronary CTO (>40 mm) is an independent predictor of post-CABG survival.
authors.affiliation: VA North Texas Health Care System, Dallas, Texas 75216, USA. subhash.banerjee@utsouthwestern.edu
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Master
authors.forename: Matthias
authors.initials: M
authors.lastname: Peltz
authors.forename: Bernice
authors.initials: B
authors.lastname: Willis
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammed
authors.forename: Bertis B
authors.initials: BB
authors.lastname: Little
authors.forename: Michael J
authors.initials: MJ
authors.lastname: DiMaio
authors.forename: Michael E
authors.initials: ME
authors.lastname: Jessen
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000401:mortality; D054059:Coronary Occlusion / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome