Clinical Study Of 64 Multi-Slice Computed Tomographic Coronary Angiography In The Diagnosis Of Chronic Total Occlusion And Prediction Of Interventional Procedure Outcome

PartⅠInvestigation of accuracy of 64 MSCT-CA in the diagnosis of chronic total occlusion lesions of coronary arteryObjective This study is to evaluate the diagnostic value of 64 Multi-Slice Computed Tomographic Coronary Angiography(64 MSCT-CA) in chronic total occlusion(CTO) lesions of coronary artery as compared with the results of conventional coronary angiography(CAG).Material and methods Between Sept.2006 and Jan.2009,eighty-seven patients(63 man,24 woman,mean age 65.2±9.9) who had at least one CTO lesion on one of the three epicardial coronary arteries on conventional CAG and underwent 64 MSCT-CA within 60 days before the procedure were enrolled.A total of 261 major epicardial coronary arteries of the 87 patients were analysed by the independent experienced senior radiologist,who was blinding to the results of conventional.Conventional CAG was regarded as the standard reference.Sensitivity,specificity,accuracy of diagnosis,error rate,positive predictive value,negative predictive value of 64 MSCT-CA in the diagnosis or exclusion of CTO lesions were evaluated.The agreement between conventional CAG and 64 MSCT-CA was tested by using Cohen's Kappa test.Result There were 95 CTO lesions detected by CAG in 87 patients.Among them,87 CTO lesions were diagnosed correctly by 64 MSCT-CA,8 CTO lesions were unable to be diagnosed by 64 MSCT-CA.Among 166 non-occluded coronary arteries diagnosed by CAG,164 non-occluded coronary arteries were diagnosed correctly by 64 MSCT-CA while 2 were diagnosed to be CTO by 64 MSCT-CA.The sensitivity of 64 MSCT-CA in diagnosing CTO is 91.6%(87/95),specificity of 98.8%(164/166), accuracy of 96.2%(251/261),error rate of 3.8%(10/261),positive predictive value of 97.8%(87/89) and negative predictive value of 95.3%(164/172),respectively.Theκstatistic demonstrated very good agreement between CAG and 64 MSCT-CA in the diagnosis of CTO(κ=0.92).Conclusion As a noninvasive imaging modality,64 MSCT-CA is a reliable and accurate diagnostic tool in the detection of CTO and highly correlate with conventional CAG.PartⅡThe application of 64 MSCT-CA in predicting the procedure outcome of PCI in chronic total occlusionObjective This study aims to evaluate the value of 64 MSCT-CA in predicting the procedure outcome of PCI of CTO through seeking for angiographic predictors of 64 MSCT-CA combined with angiographic characters of CAG and procedure outcome of PCI.Material and methods A total of 50 clinically and angiographically diagnosed CTO patients(38 man,12 woman,mean age 62.5±9.6) who were intended to implement PCI on CTO lesion were retrospectively enrolled.They had all underwent 64 MSCT-CA before PCI within 60 days.According to the result of PCI,patients were divided into PCI success group and PCI failure group.Angiographic characters of 64 MSCT-CA and CAG were compared and analyzed between two groups.Meaningful procedure outcome predictors of PCI of CTO were seek out through univariate and multivariate analysis.The predictive value of 64 MSCT-CA of PCI of CTO was evaluated.Result A total of 50 patients were enrolled,including 38(76%)man and 12(24%)women.51 CTO lesion were identified by CAG,with 23 in LAD(45.1%),23 in RCA(45.1%),5 in LCX(9.8%).PCI was successfully done in 33 CTO lesions (64.7%) while failed in 18 CTO lesions(35.3%).Univatiate analysis shows that RCA occlusion(P=0.001),multivessel disease(P=0.003),presence of bridging collaterals(p=0.003) are CAG predictors of PCI failure,lesion length greater than 11mm(P=0.006) and calcification score greater than 50(P=0.02) are 64 MSCT-CA predictors of PCI failure while LAD occlusion(P＜0.001) is CAG predictor of PCI success of CTO.Separate multivariate analysis that assessed only CAG parameters identified LAD as the multivariate predictor of successful PCI of CTO while separate multivariate analysis that assessed only 64 MSCT-CA parameters identified lesion length＞11mm(P=0.019)and calcification score greater than 50(P=0.025) as the multivariate predictor of PCI failure of CTO.When pooling all CAG and 64 MSCT-CA univariate predictors into the final logistic regression model and analyzed together,multivessel diseases(P=0.045),lesion length greater than 11mm(P=0.018)and RCA occlusion(P=0.003) were identified as the independent predictor of PCI failure of CTO.Conclusion Lesion length＞11mm,multivessel diseases,and RCA occlusion were independent predictor of PCI failure of CTO.Preprocedure 64 MSCT-CA of CTO can help predicting the outcome of PCI.