TY - JOUR
T1 - Preprocedural coronary computed tomography angiography in chronic total occlusion percutaneous coronary intervention
T2 - Insights from the PROGRESS-CTO registry
AU - Simsek, Bahadir
AU - Jaffer, Farouc A.
AU - Kostantinis, Spyridon
AU - Karacsonyi, Judit
AU - Koike, Hideki
AU - Doshi, Darshan
AU - Alaswad, Khaldoon
AU - Gorgulu, Sevket
AU - Goktekin, Omer
AU - Khatri, Jaikirshan
AU - Poommipanit, Paul
AU - Krestyaninov, Oleg
AU - Davies, Rhian
AU - ElGuindy, Ahmed
AU - Jefferson, Brian K.
AU - Patel, Taral
AU - Patel, Mitul
AU - Rinfret, Stephane
AU - Jaber, Wissam A.
AU - Nicholson, William
AU - Abi Rafeh, Nidal
AU - Yildirim, Ufuk
AU - Soylu, Korhan
AU - Allana, Salman
AU - Rangan, Bavana Venkata
AU - Mastrodemos, Olga C.
AU - Sandoval, Yader
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
The authors are grateful for the philanthropic support of our generous anonymous donors, and the philanthropic support of Drs. Mary Ann and Donald A Sens; Mrs. Diane and Dr. Cline Hickok; Mrs. Wilma and Mr. Dale Johnson; Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund; the Roehl Family Foundation; the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease (CCAD) helped support this research project.
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/11/15
Y1 - 2022/11/15
N2 - Background: Preprocedural coronary computed tomography angiography (CCTA) can be useful in procedural planning for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the clinical, angiographic and procedural characteristics and outcomes of cases with vs. without preprocedural CCTA in PROGRESS-CTO (NCT02061436). Multivariable logistic regression was used to adjust for confounding factors. Results: Of 7034 CTO PCI cases, preprocedural CCTA was used in 375 (5.3%) with increasing frequency over time. Patients with preprocedural CCTA had a higher prevalence of prior coronary artery bypass graft surgery (39% vs. 27%, p < 0.001) and angiographically unfavorable characteristics including higher prevalence of proximal cap ambiguity (52% vs. 33%, p < 0.001) and moderate/severe calcification (59% vs. 41%, p < 0.001) compared with those without CCTA. CCTA helped resolve proximal cap ambiguity in 27%, identified significant calcium not seen on diagnostic angiography in 18%, changed estimated CTO length by >5 mm in 10%, and was performed as part of initial coronary artery disease work up in 19%. CCTA cases had higher J-CTO (2.6 ± 1.2 vs. 2.3 ± 1.3, p < 0.001) and PROGRESS-CTO (1.3 ± 1.0 vs. 1.2 ± 1.0 p = 0.027) scores. After adjusting for potential confounders, cases with preprocedural CCTA had similar technical success (odds ratio [OR]: 1.18, 95% confidence interval [CI], 0.83–1.67) and incidence of major adverse cardiovascular events (OR: 1.47, 95% CI, 0.72–3.00). Conclusion: Preprocedural CCTA was used in ~5% of CTO PCI cases. While CCTA may help with procedural planning, especially in complex cases, technical success and MACE were similar with or without CCTA.
AB - Background: Preprocedural coronary computed tomography angiography (CCTA) can be useful in procedural planning for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the clinical, angiographic and procedural characteristics and outcomes of cases with vs. without preprocedural CCTA in PROGRESS-CTO (NCT02061436). Multivariable logistic regression was used to adjust for confounding factors. Results: Of 7034 CTO PCI cases, preprocedural CCTA was used in 375 (5.3%) with increasing frequency over time. Patients with preprocedural CCTA had a higher prevalence of prior coronary artery bypass graft surgery (39% vs. 27%, p < 0.001) and angiographically unfavorable characteristics including higher prevalence of proximal cap ambiguity (52% vs. 33%, p < 0.001) and moderate/severe calcification (59% vs. 41%, p < 0.001) compared with those without CCTA. CCTA helped resolve proximal cap ambiguity in 27%, identified significant calcium not seen on diagnostic angiography in 18%, changed estimated CTO length by >5 mm in 10%, and was performed as part of initial coronary artery disease work up in 19%. CCTA cases had higher J-CTO (2.6 ± 1.2 vs. 2.3 ± 1.3, p < 0.001) and PROGRESS-CTO (1.3 ± 1.0 vs. 1.2 ± 1.0 p = 0.027) scores. After adjusting for potential confounders, cases with preprocedural CCTA had similar technical success (odds ratio [OR]: 1.18, 95% confidence interval [CI], 0.83–1.67) and incidence of major adverse cardiovascular events (OR: 1.47, 95% CI, 0.72–3.00). Conclusion: Preprocedural CCTA was used in ~5% of CTO PCI cases. While CCTA may help with procedural planning, especially in complex cases, technical success and MACE were similar with or without CCTA.
KW - Chronic total occlusion
KW - Percutaneous coronary intervention
KW - Preprocedural computed tomographic angiography
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U2 - 10.1016/j.ijcard.2022.08.027
DO - 10.1016/j.ijcard.2022.08.027
M3 - Article
C2 - 35964847
AN - SCOPUS:85137107715
SN - 0167-5273
VL - 367
SP - 20
EP - 25
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -