title: Prognostic Impact of Chronic Total Occlusions: A Report From SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
abstract: The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on long-term mortality in a large prospective cohort.
  
  
  
  CTO is present in many patients with coronary artery disease and is difficult to treat with percutaneous coronary intervention.
  
  
  
  The study population consisted of all consecutive patients who underwent coronary angiography in Sweden between January 1, 2005 and January 1, 2012, who were registered in SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The patient population was heterogeneous with regard to indication for angiography (stable angina, ST-segment elevation myocardial infarction [STEMI], unstable angina or non-STEMI, and other) and treatment options. The long-term mortality rates of patients with and without CTO were compared by using shared frailty Cox proportional hazards regression adjusted for confounders. Tests were conducted for interactions between CTO and several pre-specified characteristics: indication for angiography and percutaneous coronary intervention (stable angina, STEMI, unstable angina or non-STEMI, and other), severity of coronary artery disease (1-, 2-, and 3-vessel and/or left main coronary artery disease), age, sex, and diabetes.
  
  
  
  During the study period, 14,441 patients with CTO and 75,431 patients without CTO were registered in SCAAR. CTO was associated with higher mortality (hazard ratio: 1.29; 95% confidence interval: 1.22 to 1.37; p < 0.001). In subgroup analyses, the risk attributable to CTO was lowest in patients with stable angina and highest in those with STEMI. In addition, CTO was associated with highest risk in patients under 60 years of age and with lowest risk in octogenarians. There was no interaction between CTO and either diabetes or sex, suggesting an equally adverse effect in both groups.
  
  
  
  In this large prospective observational study of patients with coronary artery disease, CTO was associated with increased mortality. This association was most prominent in younger patients and in those with acute coronary syndromes.
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: truls@wlab.gu.se.
authors: Truls
authors: T
authors: Råmunddal
authors: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors: Loes P
authors: LP
authors: Hoebers
authors: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors: José P S
authors: JP
authors: Henriques
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Christian
authors: C
authors: Dworeck
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Oskar
authors: O
authors: Angerås
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Jacob
authors: J
authors: Odenstedt
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Dan
authors: D
authors: Ioanes
authors: Department of Coronary Heart Disease, Skåne University Hospital, Lund, Sweden.
authors: Göran
authors: G
authors: Olivecrona
authors: Department of Coronary Heart Disease, Skåne University Hospital, Lund, Sweden.
authors: Jan
authors: J
authors: Harnek
authors: Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden.
authors: Ulf
authors: U
authors: Jensen
authors: Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden.
authors: Mikael
authors: M
authors: Aasa
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Per
authors: P
authors: Albertsson
authors: Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors: Hans
authors: H
authors: Wedel
authors: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Elmir
authors: E
authors: Omerovic
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D017130:Angioplasty / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: SCAAR; acute coronary syndrome(s); chronic total occlusion; coronary artery disease; percutaneous coronary intervention