PCI for Chronic Total Occlusion More Successful After Coronary CTA

By Reuters Staff

July 06, 2021

NEW YORK (Reuters Health) - The success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is improved by performing coronary computed tomography angiography (CCTA) beforehand, with numerically fewer instances of coronary perforation and periprocedural myocardial infarction, according to results of a randomized controlled trial.

The CCTA-CTO study assessed the value of preprocedural CCTA on the success rate of CTO-PCI in 400 patients; 200 received PCI with preprocedural CCTA and 200 did not (the angiography-guided control group).

The success rate of CTO-PCI was higher in the CCTA-guided group compared with the control group (93.5% vs. 84.0%; P=0.003), report Dr. Sung-Jin Hong of Yonsei University College of Medicine, in Seoul, South Korea, and colleagues.

Patients with CTO who had a high J-CTO score (2 or higher) saw higher success rates than those who did not (P for interaction=0.035).

Coronary perforations occurred in two patients (1%) in the CCTA group and eight patients (4%) in the angiography-guided group (P=0.055).

No patient in the CCTA group suffered periprocedural MI but this occurred in four patients (2%) in the angiography-guided group (P=0.123).

There were no between-group differences in total procedure and fluoroscopic times, or in the occurrence of cardiac death, target-vessel-related MI, or target-vessel revascularization at one year.

"Coronary CTA may be integral to performing safe and effective CTO-PCI by providing valuable anatomic information before and during CTO-PCI, although the low complication rate in this study indicates that larger randomized studies are required to demonstrate statistical significance," the study team writes in JACC: Cardiovascular Imaging.

"Although the current study is not the first to explore the usefulness of CCTA for CTO-PCI, it is the first to prospectively randomize patients to a CCTA-first approach and test its direct effect on procedural success," note the authors of a linked editorial.

"For the interventional cardiology community, it may be reasonable to presume that CCTA may predict CTO-PCI success by allowing a better understanding of vessel and plaque characteristics, providing a possibly improved J-CTO score. However, the current study takes CCTA one step forward: from a prediction tool to a clinically practical tool in the interventional cardiologist's toolbox," write Dr. Ronen Rubinshtein and Dr. Haim Danenberg of the Heart Institute at the Edith Wolfson Medical Center, in Holon, Israel.

The investigators "should therefore be commended for showing that CCTA is not only a prediction tool but a useful imaging tool that improves the chances of CTO recanalization by an experienced operator," they conclude.

The study received no commercial funding and the authors have indicated no relevant conflicts of interest.

SOURCE: https://bit.ly/3qnB0o1 and https://bit.ly/3j6q6l6 JACC: Cardiovascular Imaging, online June 16, 2021.