Preprocedural coronary computed tomography angiography in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. (15th November 2022)

• Record Type: Journal Article
• Authors: Simsek, Bahadir; Jaffer, Farouc A.; Kostantinis, Spyridon; Karacsonyi, Judit; Koike, Hideki; Doshi, Darshan; Alaswad, Khaldoon; Gorgulu, Sevket; Goktekin, Omer; Khatri, Jaikirshan; Poommipanit, Paul; Krestyaninov, Oleg; Davies, Rhian; ElGuindy, Ahmed; Jefferson, Brian K.; Patel, Taral; Patel, Mitul; Rinfret, Stephane; Jaber, Wissam A.; Nicholson, William; Abi Rafeh, Nidal; Yildirim, Ufuk; Soylu, Korhan; Allana, Salman; Rangan, Bavana V.; Mastrodemos, Olga C.; Sandoval, Yader; Burke, M. Nicholas; Brilakis, Emmanouil S.
• Is Part Of: International journal of cardiology. Volume 367(2022)
• Page Start: 20
• Page End: 25
• Publication Date: 2022-11-15
• Subjects: Chronic total occlusion -- Percutaneous coronary intervention -- Preprocedural computed tomographic angiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.08.027
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: 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. Highlights: Of the 7, 034 CTO PCI procedures performed between 2012-2022, preprocedural CCTA was used in 375 (5.3%). CCTA helped resolve proximal cap ambiguity in 27%, identified calcium in 18%, and changed the estimated CTO length in 10%. On multivariable analysis preprocedural CCTA was not associated with technical success or major adverse cardiovascular events.