Preprocedural coronary computed tomography angiography in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Bahadir Simsek, Farouc A. Jaffer, Spyridon Kostantinis, Judit Karacsonyi, Hideki Koike, Darshan Doshi, Khaldoon Alaswad, Sevket Gorgulu, Omer Goktekin, Jaikirshan Khatri, Paul Poommipanit, Oleg Krestyaninov, Rhian Davies, Ahmed ElGuindy, Brian K. Jefferson, Taral Patel, Mitul Patel, Stephane Rinfret, Wissam A. Jaber, William NicholsonNidal Abi Rafeh, Ufuk Yildirim, Korhan Soylu, Salman Allana, Bavana Venkata Rangan, Olga C. Mastrodemos, Yader Sandoval, M. Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)20-25
Number of pages6
JournalInternational Journal of Cardiology
Volume367
DOIs
StatePublished - Nov 15 2022
Externally publishedYes

Keywords

  • Chronic total occlusion
  • Percutaneous coronary intervention
  • Preprocedural computed tomographic angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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