Coronary CT Findings In Patients With Complete Coronary Artery Occlusion

Part Ⅰ:Long-term follow up of Patients with Coronary Artery Total occlusion and Coronary CT Angiography for Major Adverse Cardiac EventsObjectives:To evaluate the prognosis of patients with coronary total occlusion and coronary computed tomography angiography (CCTA) for Major Adverse Cardiac Events (MACE).Methods:We followed 810 patients with coronary total occlusionwho and underwent cardiac computed tomography (CT). Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in CCTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction (MI), or coronary revascularization. The endpoint was also MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization, to document the prevalence of coronary artery disease CAD and MACE in patients less than 45 years of age, and to determine whether CCTA is useful for risk stratification of this cohort.Results:Follow-up was completed in 599 patients (74%) with a median follow-up period of 550 days. At the end of the follow-up period,56 patients experienced MACE. With no event group of patients (543,90.7%) as compared to the traditional risk factors no significant difference in the prevalence of the risk factors in the two groups of patients. Vessel coronary occlusion (565,94.3%). The majority of occlusive lesions in the left anterior descending artery (244,40.7%) and right coronary artery (240,40.1%), followed by the left circumflex artery (109,18.2%), event groups and event group distribution in occlusion on there was no significant difference.239 patients with single vessel disease (39.9%),221 cases of two lesions (36.9%),139 cases of triple vessel disease (23.2%). Number of lesions in the coronary event group and non-event group, patients with single-vessel disease event group, event-free patients with single vessel disease was significantly higher than that in the event group ((41.6% vs.23.2%, P=0.007); event group, the proportion of three-vessel disease was significantly higher than the non-event group (39.3% vs.21.5%, P=0.003). ventricular wall thinning and 107 (17.9%), myocardial density 148 (24.7%), LV enlargement 60 (10.0%). event group left ventricular enlargement proportion was significantly higher than the non-event group (23.2% vs.8.7%, P=0.001).Conclusions:LV enlargement and three-vessel-diasease on CCTA findings have significant diffrences between patients with or without MACE.Part Ⅱ:Predictive value of Coronary CT Angiography of PCI Success in Chronic Total OcclusionObjective:Coronary computered tomography angioghraphy (CCTA) by CTO occlusion segment disease and calcification can provide effective information before PCI. In this study, we aim to analyze the predictive value of CCTA open the possibility of CTO intervention.Methods:Retrospectively include 955 consecutive patients from January 2009 to January 2013 in our hospital with total occlusion on CCTA. After excluding explicitly angiography non-occlusion, occlusion of blood vessels where previous revascularization treatment history, combined other heart disease patients, and MI less than 3 month, we include 272 patinets (281 lesions). All CTO lesions had CT measurements, including calcium score, the CTO occlusion proximal stump morphology, occlusion the proximal CT value, occlusion length, and to assess the collateral vessels and myocardial perfusion.Results:272 cases of patients with CTO 281 occlusion 263 patients with single artery occlusion, nine cases of double vessel occlusion.119 (42.3%) of the left anterior descending artery occlusion,60 (21.4%) of the circumflex artery occlusion,102 (36.3%) for the right coronary artery occlusion.229 cases (84.2%) patients,238 (84.7%) of CTO lesions of successful PCI,43 patients (15.8%) patients 43 (15.3%) the CTO lesions of PCI operation failed,41 patients (95.3%) lesions can not because of the guide wire. Successful PCI group CTO average occlusion time was 3.9 ± 1.0 months, PCI failure the group CTO average occlusion time was 6.3 ±2.1 months, P<0.001. PCI failure group CTO occlusion of the average length is longer than the success group (20.4 ± 11.2mm vs.15.1 ± 5.8mm, P <0.001). Occlusion proximal tissue average CT value of PCI success group than in the PCI failure group (70.2 ± 13.0HU vs 88.0HU, P<0.001). Conical stump occlusion of the PCI success group was significantly higher than the PCI failure group (P=0.013). PCI success group CTO lesions where vascular calcification score was significantly lower than the failure group (5.7 vs.61, P<0.001), total calcium score of the successful group was significantly lower than the failure group (62.5 vs.297.9, P<0.001). After multi-factor correction, occlusion length of occlusion the proximal CT value and the total calcium score related PCI operation failed. The occlusion length OR=1.133, P=0.022; occlusion of the proximal CT value OR value of 1.099, P<0.001; total calcium score OR value of 1.003, P= 0.002.Conclusion:Coronary CT angiography CCTA can provide effective information for decision-making before PCI, length of occlusion, occlusion of the proximal CT value of total calcium score is an independent predictor of PCI failure.Part III:Risk Stratification in Paitents with Coronary Total Occlusion detected by Multi-detector Computed TomographyObjectives:To document the prevalence of coronary artery disease (CAD) and major adverse cardiac events (MACE) in patients with Coronary Total Occlusion.Methods:Retrospectively include 955 consecutive patients from January 2009 to January 2013 in our hospital with total occlusion on CCTA. We followed 599 patients with coronary total occlusionwho and underwent cardiac computed tomography (CT). Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in CCTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction (MI), or coronary revascularization. The endpoint was also MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization, to document the prevalence of coronary artery disease CAD and MACE in patients less than 45 years of age, and to determine whether CCTA is useful for risk stratification of this cohort.Follow-up included the patient’s general condition, the traditional risk factors (overweight, high blood pressure, high blood sugar, high cholesterol, family history, smoking) and endpoint events (cardiac death, acute myocardial infarction, coronary artery stenting, coronary artery bypass grafting). Analysis of coronary artery occlusion lesions characteristics and MACE events by Cox regression model to find predictor of acute coronary events in patients with occlusion.Results:810 patients,599 patients (average age 58.8 ± 11.1 years old,76.1% male) successfully completed the follow-up, follow-up success rate of 74%. The median follow-up time was 550 days (QUARTILE,249 days -852 days).56 cases (9.3%) patients in the follow-up MACE events. Vessel coronary occlusion in 565 (94.3%), two occlusive lesions in 33 (5.5%), the three occlusion 1 (0.2%). Majority of occlusion in the left anterior descending artery (244 cases,40.7%) and right coronary artery (240 cases,40.1%), followed by the left circumflex artery (109 cases,18.2%).239 patients with single vessel disease (39.9%),221 cases of two lesions (36.9%),139 cases of triple vessel disease (23.2%). Significant difference in the number of lesions in the coronary event group and non-event group, higher than the non-event group the proportion of single-vessel disease event group (41.6% vs.23.2%, P=0.007), three-vessel disease was higher than in event group no event group (39.3% vs.21.5%, P=0.003). Observed in left ventricular enlargement in the event of CT is higher than the non-event group (23.2% vs.8.7%, P= 0.001). Cox regression univariate analysis, three-vessel disease (HR 3.312; 95% CI,1.67-6.58; p=0.001) and CT seen in left ventricular enlargement (HR 2.756; 95% CI, 1.48-5.13; p=0.001) meaningful; multivariate analysis found that three-vessel disease (HR 3.410; 95% CI,1.56-7.47; p=0.002) were independent predictors of MACE.Conclusion:CCTA is effective in re-stratifying patients into either a low or high post-test risk group.Part Ⅳ:Risk Stratification in Paitents with Coronary Total Occlusion detected by Calcium score from Multi-detector Computed TomographyObjective:This study aimed to explore the value of occlusive lesions of risk stratification in patients with coronary calcium score for coronary occlusion lesions in patients with long-term follow-up and calcification score.Methods:Retrospectively include 955 consecutive patients from January 2009 to January 2013 in our hospital with total occlusion on CCTA. We followed 599 patients with coronary total occlusionwho and underwent cardiac computed tomography (CT). Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in CCTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction (MI), or coronary revascularization. The endpoint was also MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization, to document the prevalence of coronary artery disease CAD and MACE in patients less than 45 years of age, and to determine whether CCTA is useful for risk stratification of this cohort.Follow-up included the patient’s general condition, the traditional risk factors (overweight, high blood pressure, high blood sugar, high cholesterol, family history, smoking) and endpoint events (cardiac death, acute myocardial infarction, coronary artery stenting, coronary artery bypass grafting).Results:Of the 810 patients,599 patients (average age 58.8 ±11.1 years old,76.1% male) successfully completed the follow-up, follow-up success rate of 74%. The median follow-up time was 550 days (QUARTILE,249 days -852 days).56 cases (9.3%) patients in the follow-up of acute coronary events. Calcium score of 0,26 (3.2%), in 810 patients, the calcium score 0-100,242 (29.9%) of calcium score 100-400,214 (26.4%), calcium score 400-1000 by 148 (18.3%), calcium score> 1000,74 (9.1%). When the no event groups calcium score<100 higher than the proportion of patients with an event group (37.8% vs. 17.9%, P=0.003). Calcium score> 400 age group is higher than the calcium score<400 group (61.0 years vs 57.5 years; P<0.001); calcium score> 400 groups of diabetes was higher than calcium score<400 group (35.2% vs 25.3%; P value=0.011). Calcium score> 400 PCI failure after bypass surgery is higher in calcium score<400 group (5.1% vs 1.8%; P=0.025), and bypass treatment is higher than in patients with calcium score<400 group (18.5% than 9.4%; P=0.001). Follow-up of 1.5 years of acute coronary events probability layered with a calcium score of 100, there is a significant difference (calcium score<100 10.3%; calcium score> 100 19.9%; log-rank p=0.009) and calcification score 400,there is no significant difference.Conclusion:Calcium score from Coronary CT angiography had effective risk stratification. in patients with coronary artery occlusion.