Key result
Male sex linked to ~3-fold higher odds of chronic total occlusion in chronic coronary syndromes.
Why the study?
The prevalence of coronary chronic total occlusions among patients with chronic coronary syndrome and their associations with clinical factors had received limited study.
Observational (n=40,161)
Yes
Odds Ratio: 2.865 (95% CI 2.685–3.058)
p-value: p=<0.001
Approximately 18% of patients with chronic coronary syndromes undergoing angiography have a chronic total occlusion, which is strongly associated with traditional cardiovascular risk factors like older age, male sex, diabetes, and smoking.
CTO prevalence nears 18% in CCS angiography patients; leaves open whether male sex and comorbidities improve risk stratification or warrant prospective trials.
Background and Aims The prevalence of coronary chronic total occlusions (CTO) among patients with chronic coronary syndrome (CCS) and their associations with clinical factors have received limited study. We analyzed a national database registry to determine the prevalence, location, and parameters associated with coronary CTOs. Methods We identified all CCS patients without prior coronary artery bypass graft surgery (CABG) who underwent coronary angiography in the Persian CardioVascular Disease Registry (PCVDR). We compared the baseline demographics and characteristics of patients with vs. without at least one CTO lesion. We used logistic regression analysis to identify parameters associated with coronary CTOs. Results Among the 40,161 patients with CCS who underwent coronary angiography between March 2019 and December 2023, 6805 (17.86%) had at least one CTO. CTO patients were significantly older (64.43 ± 8.96 years vs. 62.64 ± 9.54 years, p < 0.001) and more likely to be men (75.3% vs. 54.4%, p < 0.001). The left anterior descending artery (70.4%) and right coronary artery (16.5%) were the most common CTO lesion locations. Older age (adjusted odds ratio [aOR] 95% confidence intervals [CI] 1.024 (1.021–1.028), male gender (aOR 2.865 (2.685–3.058), any smoking (aOR 1.256 (1.145–1.378), diabetes mellitus (aOR 1.372 (1.288–1.460), and dyslipidemia (aOR 1.166 (1.096–1.239) were independently associated with the presence of a CTO. Conclusion Approximately 1 in 5 CCS patients without prior CABG undergoing coronary angiography in this national database registry had a CTO. Advanced age, male gender, history of smoking, diabetes mellitus, and dyslipidemia were associated with higher likelihood of coronary CTOs.
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Attar et al. (2025) conducted an observational in Chronic Coronary Syndromes (n=40,161). Male gender vs. Female gender was evaluated on Presence of Chronic Total Occlusion (CTO) (aOR 2.865, 95% CI 2.685-3.058, p=<0.001). Among 40,161 patients with chronic coronary syndromes undergoing coronary angiography, the prevalence of chronic total occlusion was 17.86%, with male gender being the strongest predictor (aOR 2.865).
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