Jin-Ho Choi1, Eun-Kyoung Kim2, Sung Mok Kim3, Hyungyoon Kim2, Young Bin Song2, Joo-Yong Hahn2, Seung Hyuk Choi2, Hyeon-Cheol Gwon2, Sang-Hoon Lee2, Yeon Hyeon Choe3, Jae K Oh4. 1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jhchoimd@gmail.com. 2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 3. Department of Radiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Abstract
OBJECTIVES: The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). BACKGROUND: CTO and STO may be different in pathophysiology and clinical treatment strategy. METHODS: We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. RESULTS: Coronary arteries with CTO showed longer occlusion length (cutoff ≥ 15 mm), higher distal transluminal attenuation gradient (cutoff ≥-0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥ 50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). CONCLUSIONS: Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI.
OBJECTIVES: The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). BACKGROUND: CTO and STO may be different in pathophysiology and clinical treatment strategy. METHODS: We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. RESULTS: Coronary arteries with CTO showed longer occlusion length (cutoff ≥ 15 mm), higher distal transluminal attenuation gradient (cutoff ≥-0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥ 50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). CONCLUSIONS: Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI.
Authors: Krzysztof L Bryniarski; Gerald S Werner; Kambis Mashayekhi; Jarosław Wójcik; David Hildick-Smith; George Sianos; Alfredo R Galassi; Roberto Garbo; Carlo Di Mario; Kamil Fijorek; Nicolas Boudou; Nicolaus Reifart; Leszek Bryniarski Journal: Postepy Kardiol Interwencyjnej Date: 2019-01-21 Impact factor: 1.426