title: Computed tomography in total coronary occlusions (CTTO registry): radiation exposure and predictors of successful percutaneous intervention.
abstract: OBJECTIVE
  There is no mention in the current "appropriateness criteria for CTCA" of the need of CTCA investigation prior to an attempt at recanalisation of a CTO. To define better the role of CTCA in the treatment of patients with CTOs, we performed CTCA in a consecutive cohort of eligible patients who were scheduled for percutaneous recanalisation of a CTO.
  
  
  RESULTS
  Symptomatic patients due to a CTO suitable for percutaneous treatment were included. One hundred and thirty-nine (142 CTOs) patients were studied. Overall success rate was 62.7%. By CTCA, the occlusion length was 24.9 +/- 18.3 vs. 30.7 +/- 20.7 mm in successful and failed cases (p = 0.1), but the frequency of patients with an occlusion length >15 mm was different, i.e., 63.2% vs. 82.7%, respectively (p = 0.02). Severe calcification, (> 50% CSA) was more prevalent in failed cases (54.7% vs. 35.9%, p = 0.03). Calcification at the entry of the occlusion was present in 58.5% of the failures vs. 41.6% of the successful cases (p = 0.04), while calcium at the exit was not different. The length of calcification was 8.5 +/- 8.4 vs. 5.5 +/- 6.6 mm in the failed and successful cases respectively (p = 0.027). By multivariable analysis, the only independent predictor of procedural success was the absence of severe calcification as defined by CTCA. The mean effective radiation dose of the PCI was 39.3 +/- 30.1 mSv. The mean effective radiation dose of CT scan was 22.4 mSv: 19.2 +/- 6.5 mSv for contrast-enhanced scan, 3.2 +/- 1.7 mSv for calcium scoring scan.
  
  
  CONCLUSIONS
  More severe calcified patterns, as assessed by CTCA, are seen in failed cases. The radiation exposure during a CT scan prior to a CTO PCI is considerable, and further studies are required to determine whether this extra diagnostic study is warranted.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Héctor M
authors.initials: HM
authors.lastname: García-García
authors.forename: Carlos A G
authors.initials: CA
authors.lastname: van Mieghem
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Willem B
authors.initials: WB
authors.lastname: Meijboom
authors.forename: Annick C
authors.initials: AC
authors.lastname: Weustink
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Nico R
authors.initials: NR
authors.lastname: Mollet
authors.forename: Carl Johann
authors.initials: CJ
authors.lastname: Schultz
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.forename: Martin
authors.initials: M
authors.lastname: van der Ent
authors.forename: Giorgios
authors.initials: G
authors.lastname: Sianos
authors.forename: Dick
authors.initials: D
authors.lastname: Goedhart
authors.forename: Ad
authors.initials: A
authors.lastname: den Boer
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000628:therapy; D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D017211:Treatment Failure
chemical_list: D003287:Contrast Media