Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract

Background-We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography. Methods and Results-A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2: 1 ratio. The end point was successful guidewire crossing <= 30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length >= 15 mm, severe calcification, whole luminal calcification, reattempt, and >= 12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing <= 30 minutes declined consistently from 100% to 0% according to the KCCT score (P< 0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics= 0.78 versus 0.65-0.72, P< 0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of < 4 for guidewire crossing <= 30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (P< 0.05, all). These results could be reproduced in validation data set (P< 0.05, all). Conclusions-KCCT scoring could predict successful guidewire crossing <= 30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention.