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Circ Cardiovasc Imaging. 2017 Apr;10(4). pii: e005800. doi: 10.1161/CIRCIMAGING.116.005800.

Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion: Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention.

Author information

1
From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhchoimd@gmail.com ycw717@naver.com.
2
From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography.

METHODS AND RESULTS:

A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length ≥15 mm, severe calcification, whole luminal calcification, reattempt, and ≥12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing ≤30 minutes declined consistently from 100% to 0% according to the KCCT score (P<0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics=0.78 versus 0.65-0.72, P<0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of <4 for guidewire crossing ≤30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (P<0.05, all). These results could be reproduced in validation data set (P<0.05, all).

CONCLUSIONS:

KCCT scoring could predict successful guidewire crossing ≤30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention.

KEYWORDS:

angiography; computed tomographic angiography; percutaneous coronary intervention; probability; sensitivity and specificity

PMID:
28389507
DOI:
10.1161/CIRCIMAGING.116.005800
[Indexed for MEDLINE]

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