Exploring the relationship between chronic total occlusions and mortality in coronary artery disease.

Background: Chronic total occlusions (CTOs) are common in coronary artery disease (CAD) and are known to impact survival, especially in acute myocardial infarction and cardiac arrest. However, their impact on long-term survival across the broader population with CAD remains less studied. We studied the association between the number, location, and severity of CTOs and long-term survival in a large, unselected cohort.

Methods: Patients undergoing coronary angiography in Sweden between July 2015 and December 2021 were identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Individuals with prior CABG were excluded. Patients were categorized by the number of CTOs (none, 1, or ≥ 2) and location (LAD, LCX, or RCA). Survival was assessed using Kaplan-Meier and Cox proportional hazards models.

Results: Of 202,191 patients, 88.0 % had no CTO, 9.8 % had 1 CTO, and 2.1 % had ≥2 CTOs. Survival worsened with increasing CTOs (p < 0.0001). Compared to no CTO, hazard ratios were 1.69 (95 % CI, 1.63-1.76; p < 0.001) for 1 CTO and 2.27 (95 % CI, 2.13-2.42; p < 0.001) for ≥2 CTOs. Adjusted HRs by location were 1.31 (95 % CI, 1.24-1.38; p < 0.001) for LAD, 1.59 (95 % CI, 1.52-1.66; p < 0.001) for RCA, and 1.28 (95 % CI, 1.21-1.35; p < 0.001) for LCX.

Conclusions: The presence, number, and location of CTOs significantly influence long-term survival. This provides long-term risk stratification for patients with CTO, which may improve patient selection for interventions.