Value of Multidetector CT Coronary Artery for diagnosis and risk factors of chronic total occlusion in patients with severe chest pain

Abstract

Abstract Background Differentiating chronic total occlusion (CTO) from subtotal coronary occlusions (STOs) is often challenging to make from coronary angiography. Multidetector computerized tomography (MDCT) is essential in diagnosing and differentiating CTO from STO in symptomatic patients. The study is designed to explore the value of MDCT coronary angiography in discrimination between CTO and STO and assess the risk stratification in patients with severe chest pain. Methods This study is a descriptive cross-sectional one conducted from January 2021 to June 2022. A total of fifty patients (29 males, 21 females), ages ranging from (30–80 years), with coronary artery disease CAD) presented to the hospital with severe chest pain and were suspected of having arterial occlusion. They were examined using MDCT angiography. Results The prevalence of CAD was higher in males than females (58% vs. 42%). CAD was most prevalent in the age group of 51–60 (34%). Hypertension, DM, and smoking were the most common risk of CTO of coronary arteries. The CT findings of the coronary arteries showed that 27 cases (54%) were occluded entirely, while 23 (46%) were sub-totally occluded. It was shown that coronary artery calcification (CAC) was higher in patients with STO of coronary arteries compared to patients with CTO (26 cases subtotal vs. 20 cases total occlusion). The LAD was occluded in 30% of the patients and subtotal occluded in 20%, while the RCA was occluded in 14% and 18% subtotally occluded in the patients. The LCX was least frequent to occlusion. The Odd adjusted ratio (AOR) showed that diabetic patients had 1.68 increased Odds of having CTO of coronary arteries compared to non-diabetes (AOR = 1.68, 95% CI = .397–7.089), while hypertensive had 1.42 increased odds of having CTO compared to non-hypertensive (AOR = 1.42, 95% CI= (.366-5.474)). Smokers had 2.20 increased Odds of having CTO compared to non-smokers (AOR = 2.20, 95% CI = .461-10.532) Conclusion The study concluded that MDCT angiography is reliable and helps differentiate CTO from STO Hypertension, DM, and smoking are the most significant factors for CTO of coronary arteries. MDCT is recommended as a screening imaging tool for CAD symptomatic and asymptomatic populations.