To Evaluate The Value Of Coronary Computed Tomography Angiography In Chronic Total Occlusion

Part Ⅰ The diagnostic value of coronary computed tomography angiography in chronic total occlusionObjective To evaluate the diagnostic value of coronary computed tomography angiography(CCTA)in chronic total occlusion(CTO).Material and methods All patients who had at least one CTO lesion on CAG and underwent CCTA within 60 days at Beijing Anzhen hospital from June 2013 to August 2016 were screened for enrollment in this retrospective study.A total of 594 major epicardial coronary arteries of 198 patients were analyzed by experienced senior radiologists.We evaluated the sensitivity,specificity,accuracy,negative predictive value,positive predictive value of CCTA in the diagnosis of CTO lesion and calculated Kappa coefficient to measure the consistency of the CAG and CCTA.Results A total of 221 CTO lesions were detected by CAG.The sensitivity of CCTA in diagnosing CTO lesions is 88%,specificity of 99%,accuracy7 of 95%,positive predictive value of 98%,negative predictive value of 93%.The Kappa value(K=0.89)demonstrates a good consistency between CAG and CCTA(P < 0.05).Conclusions CCTA has higher value in diagnosis of CTO lesions,which has good agreement with the CAG.The sensitivity of CCTA in diagnosing CTO lesions is 88%,specificity of 99%,accuracy of 95%.But calcified lesions,the poor image quality,and tiny blood vessels are certain limitations.Part Ⅱ To evaluate the coronary collateral circulation of chronic total occlusion by transluminal attenuation gradient and analyze the influencing factorsObjective To evaluate the coronary collateral circulation of chronic total occlusion(CTO)by transluminal attenuation gradient(TAG)and analyze the influencing factors for coronary collateral circulation.Material and methods All patients who had at least one CTO lesion on CAG and underwent coronary computed tomography angiography(CCTA)within 60 days at Beijing Anzhen hospital from June 2013 to August 2016 were screened for enrollment in this retrospective study.A total of 85 CTO lesions of 82 patients were analyzed by experienced senior cardiologists respectively.Patients were divided into two groups on the basis of Rentrop,and TAG of all CTO lesions were measured by experienced senior radiologists based on CCTA.Results TAG increased consistently according to the angiographic extent of collateral flow.Well-developed coronary collateral circulation could be predicted by TAG(cut-off≥-15.6 Hounsfield Units/10 mm;c-statistics,0.63).The sensitivity of TAG in diagnosing coronary collateral circulation is 67.9%,specificity of 69%,accuracy of 67.4%.Compared with patients with poorly-developed coronary collateral circulation group,patients with well-developed coronary collateral circulation had higher TAG,history of myocardial infarction(MI).A multiple logistic regression analysis revealed that history of MI and diabetes were independent predictors of coronary collateral circulation.Conclusions TAG moderately reflected the functional extent of coronary collateral circulation.History of MI was an independent predictor of well-developed coronary collateral circulation,while history of diabetes reflected the opposite results.Part Ⅲ To predict the failure of chronic total occlusion percutaneous coronary intervention using coronary computed tomography angiographyObjective To identify significant lesion features of chronic total occlusion(CTO)that predict the failure of percutaneous coronary intervention(PCI)using coronary computed tomography angiography(CCTA)and establish a CCTA score for grading difficulty of CTO lesions.All patients who had at least one CTO lesion on CAG and underwent CCTA within 60 days at Beijing Anzhen hospital from June 2013 to August 2016 were screened for enrollment in this retrospective study.A total of 85 CTO lesions of 82 patients were analyzed by experienced senior cardiologists respectively.We selected successful guidewire(GW)crossing within 30 min as the successful outcome.Using multivariable Logistic regression analysis to determine the lesion features that influence the failure of PCI and using ROC curve to determine the diagnosis value between CT-CTO SCORE and J-CTO SCORE.Material and methodsResults The rate of GW crossing within 30 min was 55.3%.On multivariable analysis,factors associated with GW crossing included distal cap ambiguity,side branch at entry,occlusion length≥20 mm.The probability of successful GW crossing within 30 min for each group was 85.7%,65.8%,33.3% and 0%,respectively.Areas under receiver-operator characteristic curves for the CT-CTO SCORE and J-CTO scores were 0.734 and 0.726,respectively,P<0.001.Conclusions Three variables of distal cap ambiguity,side branch at entry,occlusion length≥20 mm are the independent predictors for GW crossing.Compared with J-CTO score,CT-CTO SCORE represents an accurate tool for predicting the grades of CTO difficulty.