Predictive value of chronic total occlusion score based on coronary CT angiography in interventional treatment of chronic total occlusion of coronary artery / 中华放射学杂志

ABSTRACT

Objective:To explore the predictive value of modified chronic total occlusion (CTO) scores based on coronary computed tomography angiography (CCTA) for the outcome of CTO lesions after percutaneous coronary intervention (PCI).Methods:A total of sixty-six patients who had undergone CCTA examinations were retrospectively enrolled and divided into PCI-success group ( n=48) and PCI-failure group ( n=18). Age, body mass index (BMI), calcium score (CACS), location and extent of CTO occlusive segments were recorded and compared between the two groups using paired-samples t test. In addition, the differences of gender, hypertension, hyperlipidemia, hyperuricemia, diabetes mellitus, myocardial infarction and angina pectoris were analyzed by using chi-square test and Fisher exact test. J-CTO score based on CCTA images (J-CTO CT) was calculated. Furthermore, modified-CTO score (m-CTO CT) was measured by redefining the calcification degree (mild, severe) and range (full segment, part) in the J-CTO scoring system. Predictive value of J-CTO CT and m-CTO CT on recanalization success was evaluated by the receiver operating curve (ROC) analysis. Results:There were no significant differences in patients′ clinical indices between the two groups (all P>0.05). Compared to PCI-success group, blunt cap, blending>45 degrees, lesion length>20 mm, full calcification segment of lesion (χ 2=5.012, 3.999 and 4.103, respectively; P<0.05) occurred more frequently in the PCI-failure group. In addition, the incidence of occlusive calcification was significantly increased in the PCI-failure group ( P<0.05), as well as the total occlusive calcification ( P=0.001) and severe occlusive calcification ( P=0.000). Nevertheless, the rate of mild occlusive calcification was significantly higher in the PCI-success group ( P=0.037). There were no significant differences in calcification location, calcification score and extent of calcification ( P>0.05) between the two groups. The area under ROC (AUC) of m-CTO CT (0.921) was significantly higher than that of J-CTO CT (0.847, P<0.001). Conclusions:Morphological evaluation of CCTA is helpful to predict the surgical success in patients with PCI. m-CTO CT scoring shows higher predictive value compared to traditional J-CTO CT score.