Predictive Value Of Coronary CT Angiography In Chronic Total Occlusion Lesions Anti-interventional Therapy

Objective: Preoperative Coronary CT Angiography(CCTA)to evaluation the factors success of the chronic total occlusion(CTO)lesions anti-interventional therapy and the predictive efficacy of the guidewire in 30 minutes pass through the CTO lesions compared CT scoring system with J-CTO scoring system.Methods: All patients who were hospitalized in Department of Cardiology of the First Affiliated Hospital of Da Lian Medical University from January 2010 to June 2017 were diagnosed as CTO lesions by coronary angiography and general clinical data,285 patients with 306 CTO lesions were selected for CCTA examination within 90 days during the same period.The patients were further investigated as PCI success group vs PCI failure group according to their PCI results.General clinical data consist of gender,age,hyperlipidemia,the history of smoking,hypertension,diabetes,myocardial infarction,cerebrovascular disease,chronic obstructive pulmonary disease,family history of coronary heart disease,peripheral vascular disease History,previous history of attempted but failed and venous blood biochemical indicators(including fasting blood glucose,triglycerides,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,uric acid,creatinine)and left ventricular ejection fraction.Intraoperative use of the and the preferred type of guide wire,coronary CTA assessment parameters such as occlusion vessel position,occlusion length,bending>45°,occlusion of proximal plaque CT value and CT value of the uniformity,blunt or tapered stump,Whether there is multiple occlusion,napkin ring sign,occlusion of severe calcification(calcification arc >180°),occlusion of vascular minimum cross-sectional area of extravascular elastic membrane and reference lumen cross-section of extravascular elastic membrane area,ostial lesions,the existence of collateral circulation and the bridge Side branch,whether there is micro-channel.Chi-square test or independent sample T-test analysis between the two groups to compare the clinical data and coronary CTA parameters were statistically different or not.Multivariate Logistic Regression Analysis to evaluate the Factors of Success of CTO Lesion Anti-Intervention.ROC curve was used to calculate the cut-off value of occlusion vessel length between the two groups.The predictive efficacy of CT-CTO scoring system and J-CTO scoring system on PCI success rate was also analyzed.SPSS 24.0 was used for statistical analysis,P <0.05 considered statistically significant.Results: A total of 306 CTO lesions were enrolled in this study.216 cases were successful completely,9 cases were partially successful.There were 81 cases of anti-interventional failure,73.5% anti-guidewire success rate and 70.6% surgical success rate.Comparison of clinical data and CTA parameters between PCI success group and PCI failure group showed that in the PCI failure group,hypertension(76.7% vs 63.4%,P = 0.024),diabetes(47.8% vs 28.7%,P = 0.001),myocardial infarction(43.3% vs 21.3%,P = 0.001),Previous history of attempted but failed(6.7% vs 0.5%,P = 0.003),fasting plasma glucose(6.93± 3.0mmol/L,P = 0.047),microcatheter(26.7%vs 13.4%,P=0.008),bending >45 °(68.8% vs 31.3%,P = 0.001),blunt stump(41.1% vs 9.3%,P = 0.001),multiple occlusion(14.4% vs 13.4%,P = 0.008),The ostial lesion(15.6% vs 2.8%,P = 0.001),calcification arc> 180 °(52.2% vs 10.2%,P = 0.001)and occlusion vessel length(21.5 ± 11.2 mm vs 10.7 ± 6.8mm,P = 0.001),CT value of the uniformity(65.1 ± 63.0HU vs 32.3 ± 25.8HU,P = 0.001),collateral circulation(80.0% vs 52.3%,P = 0.001)were more than those in the PCI success group,total cholesterol(5.0 ± 1.5mmol/L vs 4.6 ± 1.5mmol/L,p = 0.039),low density lipoprotein(2.9 ± 1.1mmol/L vs 2.6 ± 0.9mmol/L,P = 0.011),LVEF(55.9 ± 7.7% vs 53.8 ± 8.1%),positive reconstruction(31.0% vs 10.0%,P = 0.001),the preferred guidewire(75.4% vs 60.0%,P = 0.007),experienced professor(75.5 vs 63.3%,P = 0.031)were less than those in the PCI success group,the difference was statistically significant.Gender,smoking history,history of COPD,history of cerebrovascular disease,hyperlipidemia,family history of coronary heart disease,age,triglyceride level,serum lipoprotein,uric acid,glomerular filtration rate,occlusion vessel position,napkin ring,bridge collateral,and micro-channel were not statistically different.Multivariate analysis showed that the bending > 45 °(OR = 6.611,95% CI: 2.010-21.752,P = 0.002)and the proximal vessel was blunt(OR = 7.554,95% CI 2.571-22.198,P = 0.001),ostial lesions(OR = 12.188,95% CI: 2.076-71.552,P = 0.006),multiple occlusion(OR = 5.794,95% CI 1.350-24.856,P = 0.018),occlusive length >14.4 mm(OR = 1.123,95% CI: 1.062-1.189,P = 0.001)were independent risk factors for failed CTO lesions and positive reconstructed(OR = 0.201,95% CI 0.056-0.719,P = 0.014)is beneficial to the CTO lesions.The predictive value of CT-CTO score system for CTO lesions was higher than that of the J-CTO score system.The areas under the curve were 0.888 and 0.874,respectively,with statistical significance.Conclusion: Preoperative CTA coronary CT scan can improve the success rate of anti-PCI surgery for CTO lesions.Preoperative CCTA was found to be bending >45 °,blunt stump in the proximal part of the occlusion,ostial lesions,multiple occlusion,and occlusive length > 14.4 mm were independent risk factors for failed CTO lesions,Positive reconstruction is beneficial to CTO lesions.The CT-CTO score system predicts guide wire pass through the occlusion lesions successfully within 30 minutes over than the J-CTO score system.CTO occlusion length >14.4mm act as the cutoff between the groups.