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

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 occlusion≥20 mm, and calcified plaque burden≥0.125. 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.