Assessment of calcium characteristics in chronic total occlusion using computed tomography coronary angiogram and implications for percutaneous coronary intervention
Sharma, Vinoda Hassan, Ahmed Kouser, Saba Lee, Leong Basavarajaiah, Sandeep Khan, Sohail Mozid, Abdul Joshi, Francis Shaukat, Aadil Kodoth, Vivek
Sharma, Vinoda
Hassan, Ahmed
Kouser, Saba
Lee, Leong
Basavarajaiah, Sandeep
Khan, Sohail
Mozid, Abdul
Joshi, Francis
Shaukat, Aadil
Kodoth, Vivek
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Publication date
2025-11-25
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Abstract
Calcification in a chronic total occlusion (CTO) is better visualised on Computed Tomography Coronary Angiography (CTCA) than invasive angiography.
Retrospective analysis of the PCI database was performed (April 2017-April 2024) (clinical trials registration: NCT06414551). Patients who underwent both CTO PCI and CTCA were grouped into successful CTO PCI and any failed attempt of CTO PCI and compared for characteristics of calcification on CTCA: site of calcification, density of calcification in Hounsfield Units (HU) and quantity of calcification in % of cross section of the vessel.
Out of 499 CTO PCIs performed, 82 patients had undergone CTCA. 51/82 (62.2 %) patients had analysable CTCAs. Mean age was 68.5 (±10.9) years and 19.6 % were female. Patients in the failed group were more likely to have calcification in the proximal cap (failed 65.4 % vs. success 24 %, p = 0.003), more dense calcification in the proximal cap (failed: 611.8 (±517) HU vs. success: 177.6 (±356) HU; p = 0.001) and proximal cap calcification quantity ≥50 % (failed: 75 % vs. success 16.7 %, p = 0.03). Proximal cap calcification ≥50 % was an independent predictor of CTO PCI failure (OR, 3.21, 95 % CI 1.29 to 7.98, p = 0.012).
Proximal cap calcification density and quantity on CTCA was associated with CTO PCI failure. Assessment of the proximal cap calcification may help with procedure planning in CTO PCI. Larger, prospective multicentre studies are required to corroborate these findings.
Citation
Sharma V, Hassan A, Kouser S, Lee L, Basavarajaiah S, Khan S, Mozid A, Joshi F, Shaukat A, Kodoth V, Ladwiniec A, Khan J. Assessment of calcium characteristics in chronic total occlusion using computed tomography coronary angiogram and implications for percutaneous coronary intervention. J Cardiovasc Comput Tomogr. 2025 Nov 25:S1934-5925(25)00562-3. doi: 10.1016/j.jcct.2025.11.079. Epub ahead of print.
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