Predicting successful percutaneous coronary intervention in patients with chronic total occlusion: the incremental value of a novel morphological parameter assessed by computed tomography.

To study the relationship between percutaneous coronary intervention (PCI) success and various morphological index evaluated by coronary computed tomography angiography (CCTA) in patients with coronary chronic total occlusion (CTO). 272 Consecutive patients with 281 CTO lesions diagnosed by CCTA and invasive coronary angiography were prospectively enrolled. The luminal attenuation of proximal segment of CTO lesions was measured. Other parameters, like lesion length, coronary calcium score, torturous course, stump morphology were also recorded. The attenuation of the proximal segment of CTO lesions was significantly higher in PCI failure group than it was in PCI success group (88 ± 19.7 vs. 70.2 ± 13, p < 0.001). Lesion length in PCI failure group was longer than those in PCI success group (20.4 ± 11.2 vs. 15.1 ± 5.85 mm, p < 0.001) and lesions in PCI failure group were more heavily calcified than lesions in PCI success group (Agatston score 61 vs. 5.7, p < 0.001). The attenuation of the proximal segment of CTO lesions, along with occlusion length and total coronary calcium score were significant independent predictors of PCI failure. The attenuation of the proximal segment of CTO lesions, along with occlusion length and total coronary calcium score as assessed by CCTA have predictive value for PCI outcomes.