CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion

Kean H. Soon, Nicholas Cox, Aaron Wong, Ivan Chaitowitz, Lachlan MacGregor, Peter T. Santos, Joseph B. Selvanayagam, H. M Omar Farouque, Salvatore Rametta, Kevin W. Bell, Yean L. Lim

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ≥50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02-0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07-0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ≥50% on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI.

LanguageEnglish
Pages359-366
Number of pages8
JournalJournal of Interventional Cardiology
Volume20
Issue number5
DOIs
Publication statusPublished - 1 Oct 2007
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Soon, Kean H. ; Cox, Nicholas ; Wong, Aaron ; Chaitowitz, Ivan ; MacGregor, Lachlan ; Santos, Peter T. ; Selvanayagam, Joseph B. ; Farouque, H. M Omar ; Rametta, Salvatore ; Bell, Kevin W. ; Lim, Yean L. / CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion. In: Journal of Interventional Cardiology. 2007 ; Vol. 20, No. 5. pp. 359-366.
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abstract = "Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ≥50{\%} as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95{\%} confidence interval [CI]: 0.02-0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95{\%} CI: 0.07-0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ≥50{\%} on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI.",
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Soon, KH, Cox, N, Wong, A, Chaitowitz, I, MacGregor, L, Santos, PT, Selvanayagam, JB, Farouque, HMO, Rametta, S, Bell, KW & Lim, YL 2007, 'CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion', Journal of Interventional Cardiology, vol. 20, no. 5, pp. 359-366. https://doi.org/10.1111/j.1540-8183.2007.00275.x

CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion. / Soon, Kean H.; Cox, Nicholas; Wong, Aaron; Chaitowitz, Ivan; MacGregor, Lachlan; Santos, Peter T.; Selvanayagam, Joseph B.; Farouque, H. M Omar; Rametta, Salvatore; Bell, Kevin W.; Lim, Yean L.

In: Journal of Interventional Cardiology, Vol. 20, No. 5, 01.10.2007, p. 359-366.

Research output: Contribution to journalArticle

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T1 - CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion

AU - Soon, Kean H.

AU - Cox, Nicholas

AU - Wong, Aaron

AU - Chaitowitz, Ivan

AU - MacGregor, Lachlan

AU - Santos, Peter T.

AU - Selvanayagam, Joseph B.

AU - Farouque, H. M Omar

AU - Rametta, Salvatore

AU - Bell, Kevin W.

AU - Lim, Yean L.

PY - 2007/10/1

Y1 - 2007/10/1

N2 - Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ≥50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02-0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07-0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ≥50% on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI.

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