When chronic total occlusions remain closed: how well is the treatment rationale documented?

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic coronary syndrome with chronic total occlusion (n=309). Intervention: Non-revascularization of chronic total occlusion. Primary outcome: Absence of a documented rationale for non-revascularization among unrevascularized CTO patients (95% CI 20-34).

Aleksandar Blivajs; Ivana Jurin; Irzal Hadžibegović

doi:10.15836/ccar2026.213

November 1, 2026Cardiologia CroaticaOpen Access

When chronic total occlusions remain closed: how well is the treatment rationale documented?

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Key result

Unrevascularized CTO occurs in ~52% of CCS patients, frequently lacking a documented rationale.

95% CI 20-34
n=309

Key Points

To evaluate how often the rationale, functional testing, and Heart Team input for leaving chronic total occlusions unrevascularized are documented in clinical practice.
Single-centre registry of consecutive patients with chronic coronary syndrome and angiographically confirmed chronic total occlusions (TIMI 0 flow, estimated duration ≥3 months) between September 2022 and October 2026.
Reviewed catheterization reports, discharge letters, and outpatient records for 162 patients with unrevascularized chronic total occlusions to identify documented clinical reasoning and functional assessments.
Among 162 patients with unrevascularized occlusions (52%; 95% CI 47–58; median age 70 years, 22% women), 43 patients (27%; 95% CI 20–34) had no clear rationale documented.
Documented rationales included non-viability or unfavorable anatomy in 39 patients (24%), absence of symptoms or ischemia in 28 (17%), comorbidities or frailty in 22 (14%), technical infeasibility in 13 (8%), patient refusal in 6 (4%), and adequate collateralization in 6 (4%).
A Heart Team decision was recorded in 32 patients (20%), ischemia testing before the decision in 66 (41%), viability assessment in 49 (30%), and at least one functional assessment in 80 (49%).

Study Design

Type

Cohort (n=309)

Multicenter

No

Structured PICO

P

Population

309 patients with chronic coronary syndrome and angiographically confirmed chronic total occlusion (including 162 unrevascularized patients with median age 70 years and 22% women) evaluated at a single center in Croatia.

E

Exposure

Non-revascularization decision and clinical documentation review (catheterization reports, discharge letters, and outpatient notes)

O

Outcome

Documented rationale for non-revascularization of chronic total occlusion following the final index treatment decision

Limitations

Single-centre registry
Retrospective review of available source documentation

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Implication

In routine clinical practice, over one quarter of patients with unrevascularized chronic total occlusions lacked a documented rationale for non-revascularization, highlighting the need for standardized documentation of clinical reasoning, functional testing, and Heart Team input.

Abstract

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Cite This Study

Blivajs et al. (2026) conducted a cohort in Chronic coronary syndrome with chronic total occlusion (n=309). Non-revascularization of chronic total occlusion was evaluated on Absence of a documented rationale for non-revascularization among unrevascularized CTO patients (95% CI 20-34). Non-revascularization of chronic total occlusions occurred in 52% of chronic coronary syndrome patients, with 27% lacking a documented treatment rationale.

synapsesocial.com/papers/6af5db360766bb45ea003112 https://doi.org/10.15836/ccar2026.213

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When chronic total occlusions remain closed: how well is the treatment rationale documented?

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

When chronic total occlusions remain closed: how well is the treatment rationale documented?

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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