Computed Tomography in Total coronary Occlusions (CTTO Registry) : radiation exposure and predictors of successful percutaneous intervention

• Published in: EuroIntervention Vol. 4; no. 5; pp. 607 - 616
• Main Authors: GARCIA-GARCIA, Héctor M, VAN MIEGHEM, Carlos A. G, SIANOS, Giorgios, GOEDHART, Dick, DEN BOER, Ad, DE FEYTER, Pim, SERRUYS, Patrick W, GONZALO, Nieves, MEIJBOOM, Willem B, WEUSTINK, Annick C, ONUMA, Yoshinobu, MOLLET, Nico R, SCHULTZ, Carl Johann, MELIGA, Emanuele, VAN DER ENT, Martin
• Format: Journal Article
• Language: English
• Published: Toulouse Société Europa Edition 01.03.2009
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Calcinosis - diagnostic imaging; Calcinosis - therapy; Cardiology. Vascular system; Cardiovascular system; Chronic Disease; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary heart disease; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - therapy; Female; Heart; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Practice Guidelines as Topic; Predictive Value of Tests; Prospective Studies; Radiation Dosage; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Registries; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed - adverse effects; Treatment Failure; Occlusion; Radiodiagnosis; Predictor; computed tomography coronary angiography; Coronary artery; Prediction; Cardiovascular disease; Coronary arteriography; Coronary heart disease; Chronic total occlusion; radiation exposure; Radiation exposure (person); Percutaneous route; Chronic; Total; Medical imagery; Computerized axial tomography; Predictive factor
• ISSN: 1774-024X
• DOI: 10.4244/eijv4i5a102

There is no mention in the current "appropriateness criteria for CTCA" of the need of CTCA investigation prior to an attempt at recanalisation of a CTO. To define better the role of CTCA in the treatment of patients with CTOs, we performed CTCA in a consecutive cohort of eligible patients who were scheduled for percutaneous recanalisation of a CTO. Symptomatic patients due to a CTO suitable for percutaneous treatment were included. One hundred and thirty-nine (142 CTOs) patients were studied. Overall success rate was 62.7%. By CTCA, the occlusion length was 24.9 +/- 18.3 vs. 30.7 +/- 20.7 mm in successful and failed cases (p = 0.1), but the frequency of patients with an occlusion length >15 mm was different, i.e., 63.2% vs. 82.7%, respectively (p = 0.02). Severe calcification, (> 50% CSA) was more prevalent in failed cases (54.7% vs. 35.9%, p = 0.03). Calcification at the entry of the occlusion was present in 58.5% of the failures vs. 41.6% of the successful cases (p = 0.04), while calcium at the exit was not different. The length of calcification was 8.5 +/- 8.4 vs. 5.5 +/- 6.6 mm in the failed and successful cases respectively (p = 0.027). By multivariable analysis, the only independent predictor of procedural success was the absence of severe calcification as defined by CTCA. The mean effective radiation dose of the PCI was 39.3 +/- 30.1 mSv. The mean effective radiation dose of CT scan was 22.4 mSv: 19.2 +/- 6.5 mSv for contrast-enhanced scan, 3.2 +/- 1.7 mSv for calcium scoring scan. More severe calcified patterns, as assessed by CTCA, are seen in failed cases. The radiation exposure during a CT scan prior to a CTO PCI is considerable, and further studies are required to determine whether this extra diagnostic study is warranted.