Predictive value of chronic total occlusion score based on coronary CT angiography in interventional treatment of chronic total occlusion of coronary artery

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-CTOCT) was calculated. Furthermore, modified-CTO score (m-CTOCT) was measured by redefining the calcification degree (mild, severe) and range (full segment, part) in the J-CTO scoring system. Predictive value of J-CTOCT and m-CTOCT 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 (χ2=5.012, 3.999 and 4.103, respectively; P 0.05) between the two groups. The area under ROC (AUC) of m-CTOCT (0.921) was significantly higher than that of J-CTOCT (0.847, P<0.001). Conclusions Morphological evaluation of CCTA is helpful to predict the surgical success in patients with PCI. m-CTOCT scoring shows higher predictive value compared to traditional J-CTOCT score. Key words: Coronary occlusion; Tomography, X-ray computed