title: Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital.
abstract: OBJECTIVE
  We sought to determine the contemporary prevalence and management of coronary chronic total occlusions (CTO) in a veteran population.
  
  
  BACKGROUND
  The prevalence and management of CTOs in various populations has received limited study.
  
  
  METHODS
  We collected clinical and angiographic data in consecutive patients that underwent coronary angiography at our institution between January 2011 and December 2012. Coronary artery disease (CAD) was defined as ≥50% diameter stenosis in ≥1 coronary artery. CTO was defined as total coronary artery occlusion of ≥3 month duration.
  
  
  RESULTS
  Among 1,699 patients who underwent angiography during the study period, 20% did not have CAD, 20% had CAD and prior coronary artery bypass graft surgery (CABG), and 60% had CAD but no prior CABG. The prevalence of CTO among CAD patients with and without prior CABG was 89 and 31%, respectively. Compared to patients without CTO, CTO patients had more co-morbidities, more extensive CAD and were more frequently referred for CABG. Percutaneous coronary intervention (PCI) to any vessel was performed with similar frequency in patients with and without CTO (50% vs. 53%). CTO PCI was performed in 30% of patients without and 15% of patients with prior CABG with high technical (82 and 75%, respectively) and procedural success rates (80 and 73%, respectively).
  
  
  CONCLUSIONS
  In a contemporary veteran population, coronary CTOs are highly prevalent and are associated with more extensive co-morbidities and higher likelihood for CABG referral. PCI was equally likely to be performed in patients with and without CTO.
authors.affiliation: Veterans Affairs North Texas Healthcare System, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Jeroudi
authors.forename: Mohammed E
authors.initials: ME
authors.lastname: Alomar
authors.forename: Tesfaldet T
authors.initials: TT
authors.lastname: Michael
authors.forename: Abdallah
authors.initials: A
authors.lastname: El Sabbagh
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
authors.forename: Owen
authors.initials: O
authors.lastname: Mogabgab
authors.forename: Eric
authors.initials: E
authors.lastname: Fuh
authors.forename: Daniel
authors.initials: D
authors.lastname: Sherbet
authors.forename: Nathan
authors.initials: N
authors.lastname: Lo
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.forename: Jerrold
authors.initials: J
authors.lastname: Grodin
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
keywords: coronary artery disease; coronary occlusion; percutaneous coronary intervention