Coronary computed tomographic angiography predicts crossing through chronic total occlusion within three guidewires

IF 1.7 4区 综合性期刊 Q2 MULTIDISCIPLINARY SCIENCES Journal of Radiation Research and Applied Sciences Pub Date : 2024-10-31 DOI:10.1016/j.jrras.2024.101166
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Abstract

Background

Coronary computed tomography angiography (CCTA) is a valuable non-invasive method for the diagnosis and treatment of coronary artery disease, especially providing important clinical decision-making basis for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). However, there is no data to discuss whether CCTA can predict the success rate of crossing through occlusive lesions within 3 guidewires.

Objective

The aim of this study was to establish a scoring model based on CCTA images to predict the success rate of CTO-PCI within 3 guidewires for grading treatment difficulty.

Methods

Data including 267 CTO lesions in 252 patients with pre-procedural CCTA were analyzed. Successfully crossing through the lesion within 3 guidewires was set as a new endpoint to eliminate operator bias and estimate surgical costs. The Guidewires of CTO (GW-CTO) score was determined by assigning an appropriate integer point for each independent predictor of this endpoint and summing all points accrued.

Results

72.3% reached the new endpoint. We identified 5 predictors. Including blunt proximal stump, both proximal and distal branches, occluded segmental curvature>45°, length of occlusion20 mm, and calcified plaque burden0.125. With the GW-CTO score rising from 0 to 5, the success rate dropped from 98.83% to 12.50%. The CTO-PCI difficulty was stratified into three grades: easy (0–1), intermediate (2–3), and difficult (4–5). The GW-CTO score yielded good predictive results, with an area under receiver-operator characteristic (ROC) curve of 0.87.

Conclusion

This model is very novel and presents a new perspective to predict the probability of successfully passing through CTO lesions within 3 guidewires. This may help grade the difficulty of CTO-PCI and determining the cost efficiency.
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冠状动脉计算机断层扫描血管造影可预测三根导丝内慢性全闭塞的穿越情况
背景冠状动脉计算机断层扫描(CCTA)是诊断和治疗冠状动脉疾病的重要无创方法,尤其是为慢性全闭塞(CTO)的经皮冠状动脉介入治疗(PCI)提供重要的临床决策依据。本研究旨在建立一个基于 CCTA 图像的评分模型,以预测 CTO-PCI 在 3 根导丝范围内的成功率,并对治疗难度进行分级。为了消除操作者的偏差并估算手术费用,将在 3 根导丝内成功穿越病变部位设为新的终点。通过为该终点的每个独立预测因素分配一个适当的整数点,并将所有累积点数相加,确定了导丝CTO(GW-CTO)得分。我们确定了 5 个预测因子。包括钝性近端残端、近端和远端分支、闭塞段曲率>45°、闭塞长度≥20 mm、钙化斑块负荷≥0.125。随着 GW-CTO 评分从 0 升至 5,成功率从 98.83% 降至 12.50%。CTO-PCI 难度分为三个等级:容易(0-1)、中等(2-3)和困难(4-5)。该模型非常新颖,为预测 3 根导丝成功通过 CTO 病变的概率提供了新的视角。这可能有助于分级 CTO-PCI 的难度和确定成本效益。
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来源期刊
自引率
5.90%
发文量
130
审稿时长
16 weeks
期刊介绍: Journal of Radiation Research and Applied Sciences provides a high quality medium for the publication of substantial, original and scientific and technological papers on the development and applications of nuclear, radiation and isotopes in biology, medicine, drugs, biochemistry, microbiology, agriculture, entomology, food technology, chemistry, physics, solid states, engineering, environmental and applied sciences.
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