Soon Kean H, Cox Nicholas, Wong Aaron, Chaitowitz Ivan, Macgregor Lachlan, Santos Peter T, Selvanayagam Joseph B, Farouque H M Omar, Rametta Salvatore, Bell Kevin W, Lim Yean L
Centre for Cardiovascular Therapeutics, Western Hospital, Melbourne, Victoria, Australia.
J Interv Cardiol. 2007 Oct;20(5):359-66. doi: 10.1111/j.1540-8183.2007.00275.x.
The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA.
Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed.
In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification > or =50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02-0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07-0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification > or =50% on CT-CA was the only significant predictor of failed PCI.
Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI.
慢性完全闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）成功率相对较低。采用CT冠状动脉造影（CT-CA）对CTO病变进行进一步评估，可能有助于更好地选择能从经皮血管重建术中获益的患者。我们旨在检测经CT-CA评估的PCI失败与CTO管腔钙化之间可能存在的关联。
对等待PCI的CTO患者进行16层CT扫描。一名心脏病专家和一名放射科医生在CT图像上评估CTO病变的管腔钙化情况，同时核心实验室的一名介入心脏病专家评估与CTO的PCI失败相关的有创荧光透视冠状动脉造影（FCA）的传统变量。分析CT和FCA变量与PCI失败相关的显著性。
在一个包含39例患者的43处CTO病变队列中，24处病变成功实现血管重建。经CT-CA评估，管腔钙化≥50%与PCI失败密切相关（PCI成功的比值比[OR]=0.10，95%置信区间[CI]：0.02-0.47，P=0.003）。FCA显示的钝端残端也与PCI失败相关（PCI成功的OR=0.24，95%CI：0.07-0.86，P=0.029）。没有显著证据支持CTO的病程、侧支和桥接侧支的存在以及FCA评估的微通道缺失与PCI失败相关。多因素分析显示，CT-CA上管腔钙化≥50%是PCI失败的唯一显著预测因素。
经CT-CA评估的严重管腔钙化是CTO的PCI失败的独立预测因素。CT-CA可能在CTO患者PCI术前评估中发挥作用。
