| Objective: The purpose of this study was to analyze the factors influencing percutaneous coronary intervention(PCI)in patients with long lesion of coronary chronic total occlusion(CTO)by coronary computed tomography angiography(CCTA),at the same time,CCTA and coronary angiography(CAG)were compared to predict the success of operation and guide wire successfully passing CTO within 30 minutes,to explore the clinical predictive value of CCTA on CTO interventional therapy,to assess whether it is better to preoperatively assess the ease of complete revascularization in CTO.Methods: From September 2015 to February 2023,a total of 114 patients with long-term coronary artery disease were checked by CCTA at People’s Hospital,China Medical University,one month before percutaneous coronary intervention(PCI)with CTO.Detailed baseline data,imaging data and surgical data were recorded,and the factors affecting the establishment of complete revascularization and the passage of guide wire within 30 minutes were analyzed,the J-CTO score based on CCTA results was compared with the J-CTO score based on CAG results to evaluate its predictive value.Results:Of the 114 patients with CTO,88(77.2%)underwent PCI and 37(32.5%) successfully passed the guide wire within 30 minutes.(1)at baseline,the previous CTO failed in PCI Group(57.7% vs 34.1%,p=0.031)and LDL-C(2.5±0.7 vs 2.1±0.6,p=0.021)were higher than those in successful group(p<0.05).(2)30 min guide wire passing aspect,baseline data,previous CABG(18.2% vs 2.7%,p=0.046)and previous PCI failure(48.1% vs 21.6%,p=0.007)in the failure group were more than those in the successful group(p<0.05).The shape of occluded stump was obtuse(71.4% vs 40.5%,p=0.002),calcification(98.7% vs 83.8%,p=0.007)and bending angle >45 °(72.7% vs51.4%,p=0.024)in the failed 30 min guide wire passing group were higher than those in the successful 30 min guide wire passing group(p<0.05).(3)logistic regression analysis showed that,the shape of the occluded stump as blunt(OR: 0.268,95%CI: 0.103-0.697,P=0.007)and failure of PCI in previous CTO lesions(OR: 0.288,95%CI: 0.105-0.794,P= 0.016)were independent risk factors for 30-minute guide wire passage during PCI.(4)ROC curve analysis showed that CTA-J-CTO score(AUC=0.678,95% CI: 0.561-0.796) was not significantly different from CAG-J-CTO score(AUC=0.651,95% CI:0.527-0.775)in predicting surgical outcomes(p=0.512).The CTA-J-CTO score was significantly different(AUC=0.769,95% CI: 0.671-0.867)compared with the CAG-J-CTO score(AUC=0.630,95%CI: 0.519-0.740)in predicting 30-minute guide wire passage(p=0.001).Conclusion: The blunt shape of the occluded stump and previous failure of PCI in CTO lesions were independent risk factors for guide wire passage within 30 minutes after operation.The CTA-J-CTO score based on CCTA was not significantly different from the CAG-J-CTO score based on CAG in predicting surgical outcome,with no significant difference between the two scores in predicting guide wire passage within 30 min,compared with CAG-J-CTO,CTA-J-CTO has better predictive efficacy. |
PDF Full Text Request