title: Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion: Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention.
abstract: BACKGROUND
  We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography.
  
  
  RESULTS
  A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length ≥15 mm, severe calcification, whole luminal calcification, reattempt, and ≥12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing ≤30 minutes declined consistently from 100% to 0% according to the KCCT score (P<0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics=0.78 versus 0.65-0.72,P<0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of <4 for guidewire crossing ≤30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (P<0.05, all). These results could be reproduced in validation data set (P<0.05, all).
  
  
  CONCLUSIONS
  KCCT scoring could predict successful guidewire crossing ≤30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention.
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhchoimd@gmail.com ycw717@naver.com.
authors.forename: Cheol-Woong
authors.initials: CW
authors.lastname: Yu
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyun-Jong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jon
authors.initials: J
authors.lastname: Suh
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Park
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Taek Kyu
authors.initials: TK
authors.lastname: Park
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sung Mok
authors.initials: SM
authors.lastname: Kim
authors.affiliation: From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.), and Department of Radiology (Y.-H.C., S.-M.K.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhchoimd@gmail.com ycw717@naver.com.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002908:Chronic Disease; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000628:therapy
keywords: angiography; computed tomographic angiography; percutaneous coronary intervention; probability; sensitivity and specificity