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Diagnostic accuracy of multi-slice computed tomography in identifying lesion characteristics in coronary total occlusion

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Abstract

We performed this study to compare the sensitivity and specificity of multi-slice computed tomography (MSCT) to coronary angiography (CA) in detecting coronary total occlusion (CTO) lesion characteristics. Moreover, we analyzed the association between these characteristics and the risk of revascularization failure. Fifty patients with confirmed CTO diagnosis were tried for revascularization using the antegrade (all 50) or retrograde (in failed nine antegrade interventions) approaches. Each patient underwent CA and MSCT before the intervention and data from both modalities were compared using the SPSS software. Successful revascularization occurred in 36 (72%) and 6 (66.7%) patients of the antegrade and retrograde groups, respectively. Compared to CA, MSCT exhibited high sensitivity in detecting CTO segment calcification (100%), size of the affected vessel (100%, area under the curve [AUC] = 0.82), distal filling of the affected segment (97.7%) and side-branching at the CTO segment (93.3%). However, it had lower sensitivity in detecting collaterals (75%) and the length of the affected segment (87.5%, AUC = 0.77). According to MSCT data, increased occlusion length > 18 mm (p = 0.01), atherosclerotic vessel wall (p = 0.02), small distal vessel size ≤ 2.75 mm (p = 0.002), proximal side-branching (p = 0.01) and calcification of the proximal cap (p = 0.007) or distal stump (p = 0.01) were associated with an increased risk of revascularization failure. MSCT exhibited high sensitivity in identifying several CTO lesion characteristics, such as lesional calcification and size of the affected vessel. However, further research is needed to improve the diagnostic accuracy of this modality and define the predictors of revascularization failure in CTO patients.

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Abbreviations

CA:

Coronary (conventional) angiography

CTA:

Computed tomography angiography

CTO:

Chronic total occlusion

MSCT:

Multi-slice computed tomography

PCI:

Percutaneous coronary intervention

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Acknowledgements

The authors would like to acknowledge the Medical and Teaching staff at Al-Azhar Faculty of Medicine and Kobri El-Kobba Military hospital for their support during conducting the study. Preliminary data from this study were presented at the 13th Annual Complex Cardiovascular Catheter Therapeutics, Florida (USA), 2017.

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Authors and Affiliations

  1. Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Islam Abdelmoneim, Ayman Sadek, Mohamed Ahmed Mosaad, Ibrahim Yassin & Yasser Radwan

  2. Specialized Heart Center, Kobri El-Kobba Military Hospital, Cairo, Egypt

    Khalid Shokry & Ahmed Magdy

  3. Faculty of Medicine, Mansoura University, Cairo, Egypt

    Mohammed Yasser Elsherbeny

  4. Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt

    Abdelrahman Ibrahim Abushouk

Authors
  1. Islam Abdelmoneim
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  2. Ayman Sadek
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  5. Yasser Radwan
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  9. Abdelrahman Ibrahim Abushouk
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Correspondence to Abdelrahman Ibrahim Abushouk.

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Abdelmoneim, I., Sadek, A., Mosaad, M.A. et al. Diagnostic accuracy of multi-slice computed tomography in identifying lesion characteristics in coronary total occlusion. Int J Cardiovasc Imaging 34, 1813–1818 (2018). https://doi.org/10.1007/s10554-018-1392-3

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  • DOI: https://doi.org/10.1007/s10554-018-1392-3

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