Development and Suggestion of a Cardiac CTA Scoring System for the Prediction of Revascularization Success in Chronic Total Occlusions (CTO) of the Coronary Arteries

Abstract

Heart 172Roller FC et al. Development Objective: Analyzing occluded segments with computed tomography angiography (CTA) prior to percutaneous coronary intervention (PCI) increased revascularization success in chronic total occlusions (CTO). The aim of our study was to develop a scoring system for the prediction of PCI success in CTO. Materials and Methods: 41 consecutive CTO patients (30 male; 63.1 years +/-8.3 standard deviation) underwent CTA prior to PCI. All CTOs were categorized by two radiologists in consensus regarding the presence of special features and without knowledge of PCI outcome. All outcome criteria were evaluated. Afterwards one point was assigned for each unequally distributed outcome criteria per CTO and all points were added up to a single score. Results: Severe calcifications (failure group 68.8 % vs. success group 28.0 %; p < 0.02) and intraluminal calcifications (68.8 %; 40.0 %), tortuosity (25.0 %; 0 %; p < 0.02), linear intrathrombus enhancement (37.5 %; 60.0 %) and distal vessel disease (68.8 %; 44.0 %) were unequally distributed. By adopting a threshold of 4 points or higher (maximum 5 points), the results were: sensitivity 31.3 %, specificity 100 %, negative predictive value (NPV) 69.4 % and positive predictive value (PPV) 100 %. The PCI complication rate was 9.8 % and the mean contrast media amount was 234.4 ml. Conclusion: With the suggested scoring system, based on five CTA criteria, PCI failure could be predicted with high PPV and specificity in our group of patients, but the NPV and sensitivity are low. However, 5 unsuccessful PCIs (13.2 %) could have been avoided and none would have been wrongly omitted. Regarding the complication rate during PCI and the high amounts of contrast media needed, a prediction system appears to be desirable and should be the object of large-scale trials.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Procedural Success Prediction Scoring Systems Used in Percutaneous Coronary Interventions for Chronic Total Occlusions: A Systematic Evaluation

“…KCCT prediction model displayed excellent discriminatory power for guidewire crossing in 30 min (AUC 0.776 vs. 0.703, respectively) and final procedural success (AUC 0.773 vs. 0.717, respectively), which was consistent in both studies. Roller et al [36] proposed a new five-item CT-based score with good prediction power (AUC 0.8232). Nonetheless, a small cohort of patients was included, and results should be confirmed in more extensive studies.…”

Preprocedural computed tomography angiography in differentiating chronic total from subtotal coronary occlusions

“…28 Other CT-derived parameters which can predict the success of a CTO-PCI include the degree and distribution of coronary calcification, degree of coronary tortuosity, distal coronary vessel size and proximal cap morphology. 27,[29][30][31][32][33][34] Scores based on preprocedural CTA have also been developed, such as CT-RECTOR and KCCT. 35,36 CT-RECTOR showed that the preprocedural CTAbased model had superior performance compared with the J-CTO angiography-based score.…”

Epicardial collateral channel for retrograded recanalization of chronic total occlusion percutaneous coronary intervention: Predictors of failure and procedural outcome

“…Several studies aimed at developing success prediction models have been carried out and the use of classical risk factors including, the length of the occlusion (>20 mm), blunt stump, CTO calcification, CTO tortuosity, and prior failed attempt, have shown good discriminatory capacity on the success of antegrade CTO PCI. There are still some noticeable limitations to CTO‐PCI intervention especially regarding the hybrid approach and retrograde recanalization .…”

“…Several studies aimed at developing success prediction models have been carried out [10][11][12] and the use of classical risk factors 13 including, the length of the occlusion (>20 mm), blunt stump, CTO calcification, CTO tortuosity, and prior failed attempt, have shown good discriminatory capacity on the success of antegrade CTO PCI.…”