Prediction of Successful CTO Percutaneous Coronary Intervention Using J-CTO Score Derived from Computed Tomography Versus Coronary Angiography

Document Type : Original Article

Authors

1 Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

2 Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

3 Department of Cardiology, Al-Azhar University, Cairo, Egypt.

4 Department of Radio-diagnostics, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

Abstract

Background: Percutaneous coronary intervention [PCI] for coronary chronic total occlusion [CTO] remains a challenge from the technical point of view.  Presence of an outcome predictor is of utmost importance.
The aim of the work: This work aimed to compare the accuracy of the CTA-derived versus conventional angiography derived J-CTO scores in prediction of the procedure difficulty and success.
Patients and Methods: Fifty patients were included. They were submitted to CTA before PCI to a CTO. They were submitted to multislice CTA, with calculation of J-CTO score for conventional and CTA before PCI in addition to standard assessment. The primary endpoint was the successful guide wire crossing within 30 minutes of the procedure time. The secondary end point was the successful GW crossing through CTO at any time with restoration of flow and achievement of < 50% residual diameter stenosis and TIMI flow grade 2 to 3.
Results: Forty and 60% required less [success] and more than 30 minutes [failure]. However, the overall success was 82.5%. The primary and secondary failure were significantly associated with  a significant increase of diabetes and previous CABG. CT derived J CTO Score has higher sensitivity and specificity for prediction of successful GW crossing within 30 minutes than CA derived J CTO score. In addition, the CT-derived J CTO score can differentiate between successful and failure patients at the cutoff point > 2 with sensitivity of 88.8 %, specificity of 73.17 % and AUC of 0.877 while the CA-derived J-CTO score can differentiate between successful and failure patients at the cutoff point >1 with sensitivity of 77.7 %, specificity of 65.85% and AUC of 0.789.
Conclusion:  CT-derived J-CTO score is a useful predictor for difficulty and time efficiency of guide wire [GW] crossing in CTOs, as well as the ultimate success of the procedure. 

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