Based On Imaging Features Of Coronary Computed Tomographic Angiography Predicts The Difficulty Of Cross Through Chronic Total Occlusion Within Three Guidewires

Background : Coronary computed tomographic angiography(CCTA)provides valuable information for clinical decision-making before chronic total occlusion(CTO)percutaneous coronary intervention(PCI).Although some studies analyzed and predicted the guide wire passing through the lesion within 30 minutes through CCTA,however,there is no data to discuss whether CCTA can predict the success rate of crossing through occlusive lesions within 3 guidewires.Objective:The aim of this study was to establish a scoring model based on CCTA images to predict the success rate of CTO-PCI within 3 guidewires for grading treatment difficulty.Methods : 267 CTO lesions of 252 patients examined by CCTA were analyzed,including clinical information and CCTA image information.By analyzing the relationship between the number of guide wires used in the operation and the success rate,the successful passage of a certain number of guide wires through the lesion is set as a new endpoint to eliminate the influence of the operator and estimate the operation cost.Under the premise of the new end point,through the statistical analysis of multiple influencing factors,the prediction model is finally established.The Guidewires of CTO(GW-CTO)score was determined by assigning an appropriate integer point for each independent predictor of this endpoint and summing all points accrued.Results:Of the lesions,72.3% reached the new endpoint.We identified 5 predictors included blunt proximal stump,both proximal and distal branches,occluded segmental curvature>45°,length of occlusion≥20mm,and calcified plaque burden≥0.125.As the GW-CTO score increased from 0 to 5,the success rate decreased from 98.83% to 12.50%.The CTO-PCI difficulty was stratified into three grades: easy(0-1),intermediate(2-4),and difficult(5).The area under receiver-operator characteristic(ROC)curves for the GW-CTO score was 0.874.Conclusion : This model can accurately predict the probability of successfully crossing through CTO lesions within 3 guidewires.This may aid in grading the difficulty of CTO-PCI and determining the cost efficiency.