Calcification on CTCA of a CTO and PCI outcomes
Research type
Research Study
Full title
Characteristics of calcification in a Chronic Total Occlusion on Computed Tomography Coronary Angiogram and percutaneous coronary intervention outcomes- a single centre observational study
IRAS ID
333718
Contact name
Vinoda Sharma
Contact email
Sponsor organisation
SWBH NHS Trust
Duration of Study in the UK
1 years, 6 months, 1 days
Research summary
A chronic total occlusion (CTO) is seen in 15-20% of patients referred for invasive coronary angiography. CTO Percutaneous Coronary Intervention (PCI) or stenting is complex and associated with lower success rates and higher procedural complication rates compared to simple stenting (1). Stenting is performed for symptoms not responsive to medical treatment.
CTO complexity is determined by several factors and various CTO complexity scores, have been shown to correlate with procedural success. One such score is the Japanese CTO score (J-CTO) score which is commonly utilised (2). This score assigns 1 point each to: angiographic CTO proximal cap (tapered or blunt), tortuosity (>450), lesion length (≥20mm), previous failure and calcification. The maximum score is 5. Scores that are ≥2 are considered difficult CTO PCI and require advanced techniques. Severe calcification is a known predictor of difficulty in performing CTO PCI (3). It is unclear as to what characteristic of the calcification is a predictor of failed CTO PCI- is it the site, density or quantity. Computed Tomography coronary angiography (CTCA) identifies calcification better than invasive angiography and another CTO difficulty score [CT-RECTOR (Computed Tomography Registry of Chronic Total Occlusion Revascularization)] has identified severe calcification on cross section of the vessel on CTCA (3, 4) as a predictor of failure of CTO PCI.
We aim to assess correlation of characteristics of calcification on CTCA with CTO PCI outcome (success or failure) by retrospective analysis of the PCI and CTCA database over the last 5 years.
References:
1.Tajti P, et al. Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies. J Am Heart Assoc. 2018;7(2).
2.Morino Y, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovascular interventions. 2011;4(2):213-21.
3.Opolski MP, et al. Coronary computed tomographic prediction rule for time-efficient guidewire crossing through chronic total occlusion: insights from the CT-RECTOR multicenter registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization). JACC Cardiovasc Interv. 2015;8(2):257-67.
4.Opolski MP, Achenbach S. CT Angiography for Revascularization of CTO: Crossing the Borders of Diagnosis and Treatment. JACC Cardiovasc Imaging. 2015;8(7):846-58.
5.Mylonas I, et al. Quantifying coronary artery calcification from a contrast-enhanced cardiac computed tomography angiography study. Eur Heart J Cardiovasc Imaging. 2014;15(2):210-5.REC name
HSC REC B
REC reference
24/NI/0046
Date of REC Opinion
19 Apr 2024
REC opinion
Further Information Favourable Opinion