A Retrospective Study on the Impact of Coronary Computed Tomography Angiography on the Success of Percutaneous Coronary Intervention in Chronic Total Occlusion

Background    Coronary computed tomographic angiography (CTA) provides valuable anatomical and functional information before and during chronic total occlusion (CTO) – percutaneous coronary intervention (PCI). Although several studies have suggested that pre-procedural CTA may improve procedural planning and success rates, its impact has not been consistently demonstrated, particularly in real-world settings and in patients with complex lesions. This retrospective study aims to evaluate the effect of preoperative coronary CTA on the success rates of PCI in patients with CTO.
Material and methods    In this single-center retrospective study, we included CTO patients who underwent PCI from January 2020 to September 2023. Participants were divided into two groups based on whether they received preoperative coronary CTA: the CTA-guided group and a angiography-guided group. The primary endpoint was the success rate of recanalization, defined as a final TIMI flow grade ≥2 and residual stenosis ≤30 %.
Results    A total of 400 CTO patients were included, with 200 in the CTA-guided group and 200 in the angiography-guided group. The success rate of recanalization was significantly higher (93.5 %) in the CTA-guided group compared to in the angiography-guided group (84.0 %, p=0.003). In high-difficulty CTO cases (based on the Japanese CTO score system J-CTO score ≥2), the advantage of the CTA-guided group was more pronounced (82.0 %, p < 0.001). Regarding perioperative complications, the incidence of myocardial infarction within 24 hrs was 2.5 % in the CTA-guided group compared with 5.0 % in the angiography-guided group (p=0.047), and coronary perforation occurred in 1.0 % vs. 3.5 % of patients, respectively (p=0.035). However, At the 1 yr follow-up, there was no significant difference in major adverse cardiac events between the two groups (CTA-guided 4.5 % vs. angiography-guided 7.0 %, p=0.11), including cardiac death (1.0 % vs. 2.0 %, p=0.10) and recurrent myocardial infarction (2.0 % vs. 3.5 %, p=0.15).
Conclusion    The use of preoperative coronary CTA in CTO-PCI is associated with higher success rates, particularly in high-difficulty CTO cases. Additionally, CTA-guided PCI was associated with a reduction in perioperative complications such as myocardial infarction and coronary perforation. Further multicenter, randomized studies are warranted to evaluate its impact on long-term cardiovascular outcomes.

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