Preprocedural coronary computed tomography angiography in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry.

Abstract

BACKGROUND:

Preprocedural coronary computed tomography angiography (CCTA) can be useful in procedural planning for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS:

We examined the clinical, angiographic and procedural characteristics and outcomes of cases with vs. without preprocedural CCTA in PROGRESS-CTO (NCT02061436). Multivariable logistic regression was used to adjust for confounding factors.

RESULTS:

Of 7034 CTO PCI cases, preprocedural CCTA was used in 375 (5.3%) with increasing frequency over time. Patients with preprocedural CCTA had a higher prevalence of prior coronary artery bypass graft surgery (39% vs. 27%, p < 0.001) and angiographically unfavorable characteristics including higher prevalence of proximal cap ambiguity (52% vs. 33%, p < 0.001) and moderate/severe calcification (59% vs. 41%, p < 0.001) compared with those without CCTA. CCTA helped resolve proximal cap ambiguity in 27%, identified significant calcium not seen on diagnostic angiography in 18%, changed estimated CTO length by >5 mm in 10%, and was performed as part of initial coronary artery disease work up in 19%. CCTA cases had higher J-CTO (2.6 ± 1.2 vs. 2.3 ± 1.3, p < 0.001) and PROGRESS-CTO (1.3 ± 1.0 vs. 1.2 ± 1.0 p = 0.027) scores. After adjusting for potential confounders, cases with preprocedural CCTA had similar technical success (odds ratio [OR]: 1.18, 95% confidence interval [CI], 0.83-1.67) and incidence of major adverse cardiovascular events (OR: 1.47, 95% CI, 0.72-3.00).

CONCLUSION:

Preprocedural CCTA was used in ~5% of CTO PCI cases. While CCTA may help with procedural planning, especially in complex cases, technical success and MACE were similar with or without CCTA.

• Authors: Bahadir Simsek, Farouc A Jaffer, Spyridon Kostantinis, Judit Karacsonyi, Hideki Koike, Darshan Doshi, Khaldoon Alaswad, Sevket Gorgulu, Omer Goktekin, Jaikirshan Khatri, Paul Poommipanit, Oleg Krestyaninov, Rhian Davies, Ahmed ElGuindy, Brian K Jefferson, Taral Patel, Mitul Patel, Stephane Rinfret, Wissam A Jaber, William Nicholson, Nidal Abi Rafeh, Ufuk Yildirim, Korhan Soylu, Salman Allana, Bavana V Rangan, Olga C Mastrodemos, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis
• Journal: International journal of cardiology (Int J Cardiol) Vol. 367 Pg. 20-25 (11 15 2022) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 35964847 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2022 Elsevier B.V. All rights reserved.

Chemical References

• Calcium

Topics

• Calcium
• Chronic Disease
• Computed Tomography Angiography
• Coronary Angiography (methods)
• Coronary Occlusion (diagnostic imaging, surgery)
• Humans
• Percutaneous Coronary Intervention (methods)
• Registries
• Risk Factors
• Treatment Outcome