TY - JOUR
T1 - Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography
AU - Choi, Jin Ho
AU - Kim, Eun Kyoung
AU - Kim, Sung Mok
AU - Kim, Hyungyoon
AU - Song, Young Bin
AU - Hahn, Joo Yong
AU - Choi, Seung Hyuk
AU - Gwon, Hyeon Cheol
AU - Lee, Sang Hoon
AU - Choe, Yeon Hyeon
AU - Oh, Jae K.
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/8/17
Y1 - 2015/8/17
N2 - 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.
AB - 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.
KW - chronic total occlusion
KW - coronary CT angiography
KW - percutaneous coronary intervention
KW - subtotal occlusion
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U2 - 10.1016/j.jcin.2015.03.042
DO - 10.1016/j.jcin.2015.03.042
M3 - Article
C2 - 26292581
AN - SCOPUS:84939501972
SN - 1936-8798
VL - 8
SP - 1143
EP - 1153
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -