Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography
Abstract Objectives The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (C...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2015-08, Vol.8 (9), p.1143-1153 |
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| creator | Choi, Jin-Ho, MD, PhD Kim, Eun-Kyoung, MD Kim, Sung Mok, MD, PhD Kim, Hyungyoon, MD Song, Young Bin, MD, PhD Hahn, Joo-Yong, MD, PhD Choi, Seung Hyuk, MD, PhD Gwon, Hyeon-Cheol, MD, PhD Lee, Sang-Hoon, MD, PhD Choe, Yeon Hyeon, MD, PhD Oh, Jae K., MD |
| description | Abstract Objectives The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). Background CTO and STO may be different in pathophysiology and clinical treatment strategy. Methods We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. Results Coronary arteries with CTO showed longer occlusion length (cutoff ≥15 mm), higher distal transluminal attenuation gradient (cutoff ≥−0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). Conclusions Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI. |
| doi_str_mv | 10.1016/j.jcin.2015.03.042 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1706207704</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1936879815008390</els_id><sourcerecordid>1706207704</sourcerecordid><originalsourceid>FETCH-LOGICAL-c521t-811039b92780cf8d481eacdf488d239430658af7ae8e431abf0d1c7f86e6b3b3</originalsourceid><addsrcrecordid>eNp9kU9r3DAUxE1padIkX6CH4mMvdp8kW5KhFML2L4TmkL0LWX5O5NrSVrIX9thvHpndlpBDTxrEzMD7TZa9JVASIPzDUA7GupICqUtgJVT0RXZOpOCF4FC_TLphvJCikWfZmxgHAA6NoK-zM8ppQ2tJzrM_P72zbq-j3WP-2UYT7GSdnq13ue_zjQ_e6XDINw9JWJNv_azH_NaYcYmrR7suv1va-dl3e3gS9dNumbFL2cnfB717OOTX7t6e9GX2qtdjxKvTe5Ftv37Zbr4XN7fffmyubwpTUzIXkhBgTdtQIcH0sqskQW26vpKyo6ypGPBa6l5olFgxotseOmJELznylrXsInt_rN0F_3vBOKspXYvjqB36JSoigFMQAqpkpUerCT7GgL3aJSrpFEVAreTVoFbyaiWvgKlEPoXenfqXdsLuX-Qv6mT4eDRgOnJvMahoLDqDnQ1oZtV5-__-T8_iZrRpET3-wgPGwS_BJXyKqEgVqLt1-3V6UgNI1gB7BBwQrF8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1706207704</pqid></control><display><type>article</type><title>Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Choi, Jin-Ho, MD, PhD ; Kim, Eun-Kyoung, MD ; Kim, Sung Mok, MD, PhD ; Kim, Hyungyoon, MD ; Song, Young Bin, MD, PhD ; Hahn, Joo-Yong, MD, PhD ; Choi, Seung Hyuk, MD, PhD ; Gwon, Hyeon-Cheol, MD, PhD ; Lee, Sang-Hoon, MD, PhD ; Choe, Yeon Hyeon, MD, PhD ; Oh, Jae K., MD</creator><creatorcontrib>Choi, Jin-Ho, MD, PhD ; Kim, Eun-Kyoung, MD ; Kim, Sung Mok, MD, PhD ; Kim, Hyungyoon, MD ; Song, Young Bin, MD, PhD ; Hahn, Joo-Yong, MD, PhD ; Choi, Seung Hyuk, MD, PhD ; Gwon, Hyeon-Cheol, MD, PhD ; Lee, Sang-Hoon, MD, PhD ; Choe, Yeon Hyeon, MD, PhD ; Oh, Jae K., MD</creatorcontrib><description>Abstract Objectives The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). Background CTO and STO may be different in pathophysiology and clinical treatment strategy. Methods We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. Results Coronary arteries with CTO showed longer occlusion length (cutoff ≥15 mm), higher distal transluminal attenuation gradient (cutoff ≥−0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). Conclusions Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI.</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2015.03.042</identifier><identifier>PMID: 26292581</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiovascular ; Chronic Disease ; chronic total occlusion ; Collateral Circulation ; Contrast Media ; Coronary Angiography - methods ; Coronary Circulation ; coronary CT angiography ; Coronary Occlusion - diagnostic imaging ; Coronary Occlusion - physiopathology ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; percutaneous coronary intervention ; Predictive Value of Tests ; Severity of Illness Index ; subtotal occlusion ; Vascular Patency</subject><ispartof>JACC. Cardiovascular interventions, 2015-08, Vol.8 (9), p.1143-1153</ispartof><rights>American College of Cardiology Foundation</rights><rights>2015 American College of Cardiology Foundation</rights><rights>Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c521t-811039b92780cf8d481eacdf488d239430658af7ae8e431abf0d1c7f86e6b3b3</citedby><cites>FETCH-LOGICAL-c521t-811039b92780cf8d481eacdf488d239430658af7ae8e431abf0d1c7f86e6b3b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1936879815008390$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26292581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Choi, Jin-Ho, MD, PhD</creatorcontrib><creatorcontrib>Kim, Eun-Kyoung, MD</creatorcontrib><creatorcontrib>Kim, Sung Mok, MD, PhD</creatorcontrib><creatorcontrib>Kim, Hyungyoon, MD</creatorcontrib><creatorcontrib>Song, Young Bin, MD, PhD</creatorcontrib><creatorcontrib>Hahn, Joo-Yong, MD, PhD</creatorcontrib><creatorcontrib>Choi, Seung Hyuk, MD, PhD</creatorcontrib><creatorcontrib>Gwon, Hyeon-Cheol, MD, PhD</creatorcontrib><creatorcontrib>Lee, Sang-Hoon, MD, PhD</creatorcontrib><creatorcontrib>Choe, Yeon Hyeon, MD, PhD</creatorcontrib><creatorcontrib>Oh, Jae K., MD</creatorcontrib><title>Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>Abstract Objectives The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). Background CTO and STO may be different in pathophysiology and clinical treatment strategy. Methods We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. Results Coronary arteries with CTO showed longer occlusion length (cutoff ≥15 mm), higher distal transluminal attenuation gradient (cutoff ≥−0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). Conclusions Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI.</description><subject>Cardiovascular</subject><subject>Chronic Disease</subject><subject>chronic total occlusion</subject><subject>Collateral Circulation</subject><subject>Contrast Media</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Circulation</subject><subject>coronary CT angiography</subject><subject>Coronary Occlusion - diagnostic imaging</subject><subject>Coronary Occlusion - physiopathology</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multidetector Computed Tomography</subject><subject>percutaneous coronary intervention</subject><subject>Predictive Value of Tests</subject><subject>Severity of Illness Index</subject><subject>subtotal occlusion</subject><subject>Vascular Patency</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAUxE1padIkX6CH4mMvdp8kW5KhFML2L4TmkL0LWX5O5NrSVrIX9thvHpndlpBDTxrEzMD7TZa9JVASIPzDUA7GupICqUtgJVT0RXZOpOCF4FC_TLphvJCikWfZmxgHAA6NoK-zM8ppQ2tJzrM_P72zbq-j3WP-2UYT7GSdnq13ue_zjQ_e6XDINw9JWJNv_azH_NaYcYmrR7suv1va-dl3e3gS9dNumbFL2cnfB717OOTX7t6e9GX2qtdjxKvTe5Ftv37Zbr4XN7fffmyubwpTUzIXkhBgTdtQIcH0sqskQW26vpKyo6ypGPBa6l5olFgxotseOmJELznylrXsInt_rN0F_3vBOKspXYvjqB36JSoigFMQAqpkpUerCT7GgL3aJSrpFEVAreTVoFbyaiWvgKlEPoXenfqXdsLuX-Qv6mT4eDRgOnJvMahoLDqDnQ1oZtV5-__-T8_iZrRpET3-wgPGwS_BJXyKqEgVqLt1-3V6UgNI1gB7BBwQrF8</recordid><startdate>20150817</startdate><enddate>20150817</enddate><creator>Choi, Jin-Ho, MD, PhD</creator><creator>Kim, Eun-Kyoung, MD</creator><creator>Kim, Sung Mok, MD, PhD</creator><creator>Kim, Hyungyoon, MD</creator><creator>Song, Young Bin, MD, PhD</creator><creator>Hahn, Joo-Yong, MD, PhD</creator><creator>Choi, Seung Hyuk, MD, PhD</creator><creator>Gwon, Hyeon-Cheol, MD, PhD</creator><creator>Lee, Sang-Hoon, MD, PhD</creator><creator>Choe, Yeon Hyeon, MD, PhD</creator><creator>Oh, Jae K., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150817</creationdate><title>Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography</title><author>Choi, Jin-Ho, MD, PhD ; Kim, Eun-Kyoung, MD ; Kim, Sung Mok, MD, PhD ; Kim, Hyungyoon, MD ; Song, Young Bin, MD, PhD ; Hahn, Joo-Yong, MD, PhD ; Choi, Seung Hyuk, MD, PhD ; Gwon, Hyeon-Cheol, MD, PhD ; Lee, Sang-Hoon, MD, PhD ; Choe, Yeon Hyeon, MD, PhD ; Oh, Jae K., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c521t-811039b92780cf8d481eacdf488d239430658af7ae8e431abf0d1c7f86e6b3b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Cardiovascular</topic><topic>Chronic Disease</topic><topic>chronic total occlusion</topic><topic>Collateral Circulation</topic><topic>Contrast Media</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Circulation</topic><topic>coronary CT angiography</topic><topic>Coronary Occlusion - diagnostic imaging</topic><topic>Coronary Occlusion - physiopathology</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multidetector Computed Tomography</topic><topic>percutaneous coronary intervention</topic><topic>Predictive Value of Tests</topic><topic>Severity of Illness Index</topic><topic>subtotal occlusion</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Choi, Jin-Ho, MD, PhD</creatorcontrib><creatorcontrib>Kim, Eun-Kyoung, MD</creatorcontrib><creatorcontrib>Kim, Sung Mok, MD, PhD</creatorcontrib><creatorcontrib>Kim, Hyungyoon, MD</creatorcontrib><creatorcontrib>Song, Young Bin, MD, PhD</creatorcontrib><creatorcontrib>Hahn, Joo-Yong, MD, PhD</creatorcontrib><creatorcontrib>Choi, Seung Hyuk, MD, PhD</creatorcontrib><creatorcontrib>Gwon, Hyeon-Cheol, MD, PhD</creatorcontrib><creatorcontrib>Lee, Sang-Hoon, MD, PhD</creatorcontrib><creatorcontrib>Choe, Yeon Hyeon, MD, PhD</creatorcontrib><creatorcontrib>Oh, Jae K., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Choi, Jin-Ho, MD, PhD</au><au>Kim, Eun-Kyoung, MD</au><au>Kim, Sung Mok, MD, PhD</au><au>Kim, Hyungyoon, MD</au><au>Song, Young Bin, MD, PhD</au><au>Hahn, Joo-Yong, MD, PhD</au><au>Choi, Seung Hyuk, MD, PhD</au><au>Gwon, Hyeon-Cheol, MD, PhD</au><au>Lee, Sang-Hoon, MD, PhD</au><au>Choe, Yeon Hyeon, MD, PhD</au><au>Oh, Jae K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2015-08-17</date><risdate>2015</risdate><volume>8</volume><issue>9</issue><spage>1143</spage><epage>1153</epage><pages>1143-1153</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>Abstract Objectives The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). Background CTO and STO may be different in pathophysiology and clinical treatment strategy. Methods We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. Results Coronary arteries with CTO showed longer occlusion length (cutoff ≥15 mm), higher distal transluminal attenuation gradient (cutoff ≥−0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). Conclusions Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26292581</pmid><doi>10.1016/j.jcin.2015.03.042</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiovascular Chronic Disease chronic total occlusion Collateral Circulation Contrast Media Coronary Angiography - methods Coronary Circulation coronary CT angiography Coronary Occlusion - diagnostic imaging Coronary Occlusion - physiopathology Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Diagnosis, Differential Female Humans Male Middle Aged Multidetector Computed Tomography percutaneous coronary intervention Predictive Value of Tests Severity of Illness Index subtotal occlusion Vascular Patency |
| title | Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography |
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