Xing Haoran, Zhang Lijun, Zhang Dongfeng, Wang Rui, Tian Jinfan, Le Yinghui, Ju Zhiguo, Chen Hui, He Yi, Song Xiantao
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China.
Quant Imaging Med Surg. 2022 Jul;12(7):3625-3639. doi: 10.21037/qims-21-1050.
Morphological and clinical characteristics are widely used to predict the success of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO). However, the impact of quantitative characteristics derived from coronary computed tomography angiography (CCTA) on guidewire crossing and PCI success is still unclear. This study aimed to explore the association between these quantitative characteristics and the difficulty of PCI for CTO.
A total of 207 CTO lesions from 201 patients (84.6% male; mean age 58.9 years) with pre-procedural CCTA scans who had undergone PCI for CTO were retrospectively enrolled in this case-control study. A semi-automated CCTA plaque-analysis software was adopted to obtain the total plaque volume and volume of each component according to the Hounsfield Unit (HU) value, including dense calcium (>351 HU), fibrous (131-350 HU), fibrofatty (76-130 HU), and necrotic core (-30-75 HU) tissue. Differences in the quantitative characteristics of the CTO lesions were compared between: (I) the group of lesions with successful guidewire crossing (≤30 min) and the group with failed guidewire crossing (≤30 min); (II) the group of lesions with procedural success [defined as achieving residual stenosis of <30% and a grade 3 thrombolysis in myocardial infarction (TIMI) flow] and the group with procedural failure. Logistic regression was used to explore the association of quantitative characteristics with successful guidewire crossing in ≤30 min and procedural success.
A total of 131 (63.3%) lesions of 126 patients achieved successful guidewire crossing in ≤30 min and 157 (75.8%) lesions of 152 (75.6%) patients achieved procedural success. Quantitative characteristics such as occlusion length, plaque volume, volume of dense calcium, and fibrous and fibrofatty tissue showed significant differences between the groups of lesions with successful guidewire crossing in ≤30 min and with failed guidewire crossing in ≤30 min, as well as the groups of lesions with procedural success and with procedural failure. According to the results of logistic regression analysis, lower percentages of dense calcium [odds ratio (OR) =0.970, 95% confidence interval (CI): 0.950 to 0.991; P=0.004] and fibrous (OR =0.970, 95% CI: 0.949 to 0.992; P=0.007) tissue and higher percentage of necrotic core tissue (OR =1.018, 95% CI: 1.005 to 1.030; P=0.005) were significantly associated with successful guidewire crossing in ≤30 min. Decreased percentages of dense calcium (OR =0.969; 95% CI: 0.949 to 0.989; P=0.002) and fibrous tissue (OR =0.966, 95% CI: 0.944 to 0.990; P=0.005) and higher percentage of necrotic core tissue (OR =1.022, 95% CI: 1.008 to 1.036; P=0.002) were associated with procedural success. After adjusting for cardiovascular risk factors, the percentages of dense calcium, fibrous, and necrotic core tissue were still associated with successful guidewire crossing in ≤30 min, and the quantitative parameters showed consistent association with procedural success.
Quantitative characteristics derived from CCTA for CTO are associated with successful guidewire crossing and procedural success of PCI.
形态学和临床特征被广泛用于预测慢性完全闭塞（CTO）患者经皮冠状动脉介入治疗（PCI）的成功率。然而，冠状动脉计算机断层扫描血管造影（CCTA）得出的定量特征对导丝通过及PCI成功率的影响仍不明确。本研究旨在探讨这些定量特征与CTO患者PCI难度之间的关联。
本病例对照研究回顾性纳入了201例接受CTO-PCI且术前有CCTA扫描的患者的207处CTO病变（男性占84.6%；平均年龄58.9岁）。采用半自动CCTA斑块分析软件，根据亨氏单位（HU）值获取总斑块体积及各成分体积，包括致密钙（>351 HU）、纤维（131 - 350 HU）、纤维脂肪（76 - 130 HU）和坏死核心（-30 - 75 HU）组织。比较CTO病变定量特征在以下两组之间的差异：（I）导丝成功通过（≤30分钟）的病变组与导丝通过失败（>30分钟）的病变组；（II）手术成功[定义为残余狭窄<30%且心肌梗死溶栓分级（TIMI）血流达3级]的病变组与手术失败的病变组。采用逻辑回归分析探讨定量特征与30分钟内导丝成功通过及手术成功之间的关联。
126例患者的131处（63.3%）病变在≤30分钟内实现导丝成功通过，152例（75.6%）患者的157处（75.8%）病变实现手术成功。闭塞长度、斑块体积、致密钙体积以及纤维和纤维脂肪组织等定量特征在≤30分钟内导丝成功通过的病变组与>30分钟内导丝通过失败的病变组之间，以及手术成功的病变组与手术失败的病变组之间均显示出显著差异。根据逻辑回归分析结果，致密钙组织百分比降低[比值比（OR）=0.970，95%置信区间（CI）：0.950至0.991；P = 0.004]、纤维组织百分比降低（OR =0.970，95% CI：0.949至0.992；P = 0.007）以及坏死核心组织百分比升高（OR =1.018，95% CI：1.005至1.030；P = 0.005）与≤30分钟内导丝成功通过显著相关。致密钙组织百分比降低（OR =0.969；95% CI：0.949至0.989；P = 0.002）、纤维组织百分比降低（OR =0.966，95% CI：0.944至0.990；P = 0.005）以及坏死核心组织百分比升高（OR =1.022，95% CI：1.008至1.036；P = 0.002）与手术成功相关。在调整心血管危险因素后，致密钙、纤维和坏死核心组织百分比仍与≤30分钟内导丝成功通过相关，且定量参数与手术成功显示出一致的关联。
CCTA得出的CTO定量特征与PCI的导丝成功通过及手术成功相关。
