冠状动脉计算机断层血管造影获得的 Euro CTO（CASTLE）评分对预测慢性完全闭塞病变 30 分钟内导丝通过的准确性。
Accuracy of the Euro CTO(CASTLE) score obtained on coronary computed tomography angiography for Predicting 30-minute wire crossing in chronic total occlusions.
机构信息
School of Graduate, Dalian Medical University, Lushunkou District, No. 9, West Section of Lushun South Road, Dalian, 116041, China.
Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China.
出版信息
BMC Cardiovasc Disord. 2022 Apr 19;22(1):184. doi: 10.1186/s12872-022-02627-4.
BACKGROUND
To investigate the feasibility and accuracy of the Euro CTO (CASTLE) score obtained on coronary computed tomography angiography (CCTA) for predicting the success of percutaneous coronary intervention (PCI) and the 30-min wire crossing in chronic total occlusions (CTO).
METHOD
One hundred and fifty patients (154 CTO cases; median age, 61 (interquartile range [IQR], 54-68) years; 75.3% male) received CCTA at the People's Hospital of Liaoning Provincce within 1 month before the procedure. The Euro CTO (CASTLE) score obtained on CCTA(CASTLE) was calculated and compared with the Euro CTO (CASTLE) score obtained based on coronary angiography (CASTLE) for the predictive value of 30-min wire crossing and CTO procedural success.
RESULTS
In our study, the CTO-PCI success rate was 89.0%, with guidewires of 65 cases (42.2%) crossing within 30 min. There were no significant differences in the median CASTLE and CASTLE scores in the procedure success group (3 [IQR, 2-4] vs 3 (IQR, 2-3]; p = 0.126). However, the median CASTLE score was significantly higher than the median CASTLE score in the procedure failure group (4 [IQR, 3-5.5] vs 4 [IQR, 2.5-5.5]; p = 0.021). There was no significant difference between the median CASTLE score and the median CASTLE score in the 30-min wire crossing failure group (3 [IQR, 3-4] vs 3 [IQR, 2-4]; p = 0.254). However, the median CASTLE score was significantly higher than the median CASTLE score in the 30-min wire crossing group (3 [IQR, 2-3] vs 2 [IQR, 2-3]; p < 0.001). The CASTLE score described higher levels of calcification than the CASTLE score (48.1% vs 33.8%; p = 0.015). There was no significant difference between the CASTLE score (area under the curve [AUC], 0.643; 95% confidence interval [CI], 0.561-0.718) and the CASTLE score (AUC, 0.685; 95% CI, 0.606-0.758) for predicting procedural success (p = 0.488). The CASTLE score (AUC, 0.744; 95% CI, 0.667-0.811) was significantly better than the CASTLE score (AUC, 0.681; 95% CI, 0.601-0.754; p = 0.046) for predicting 30-min wire crossing with the best cut-off value being CASTLE ≤ 3. The sensitivity, specificity, positive predictive value, and negative predictive value were 90.8%, 55.2%, 54.6%, and 87.0%, respectively.
CONCLUSION
The CASTLE scores obtained from noninvasive CCTA perform better for the prediction of the 30-min wire crossing than the CASTLE score.
背景
本研究旨在探讨基于冠状动脉计算机断层扫描血管造影（CCTA）的 Euro CTO（CASTLE）评分预测慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）和 30 分钟内导丝通过的可行性和准确性。
方法
本研究纳入了 150 名患者（154 例 CTO 病变；中位年龄 61 岁（四分位距 [IQR]，54-68 岁）；75.3%为男性），于辽宁省人民医院行 CTO 病变前 1 个月内行 CCTA。计算 CCTA （CASTLE）与冠状动脉造影（CASTLE）获得的 Euro CTO（CASTLE）评分，并比较其对 30 分钟内导丝通过和 CTO 介入治疗成功的预测价值。
结果
本研究中 CTO-PCI 成功率为 89.0%，其中 65 例（42.2%）导丝在 30 分钟内通过。在手术成功组与手术失败组中，CASTLE 和 CASTLE 评分的中位数差异无统计学意义（3 [IQR，2-4] 比 3 [IQR，2-3]；p=0.126）。然而，CASTLE 评分的中位数在手术失败组中明显高于手术成功组（4 [IQR，3-5.5] 比 4 [IQR，2.5-5.5]；p=0.021）。在 30 分钟内导丝通过失败组和导丝通过成功组中，CASTLE 评分的中位数差异无统计学意义（3 [IQR，3-4] 比 3 [IQR，2-4]；p=0.254）。然而，CASTLE 评分的中位数在 30 分钟内导丝通过失败组中明显高于导丝通过成功组（3 [IQR，2-3] 比 2 [IQR，2-3]；p<0.001）。CASTLE 评分描述的钙化程度高于 CASTLE 评分（48.1%比 33.8%；p=0.015）。CASTLE 评分（曲线下面积 [AUC]，0.643；95%置信区间 [CI]，0.561-0.718）和 CASTLE 评分（AUC，0.685；95% CI，0.606-0.758）对预测手术成功率的差异无统计学意义（p=0.488）。CASTLE 评分（AUC，0.744；95% CI，0.667-0.811）对预测 30 分钟内导丝通过的效果明显优于 CASTLE 评分（AUC，0.681；95% CI，0.601-0.754；p=0.046），最佳截断值为 CASTLE≤3。CASTLE 评分的灵敏度、特异度、阳性预测值和阴性预测值分别为 90.8%、55.2%、54.6%和 87.0%。
结论
非侵入性 CCTA 获得的 CASTLE 评分在预测 30 分钟内导丝通过方面优于 CASTLE 评分。
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