| 조정래¹, 김영진² ,문재연¹ ,김동연¹ ,김현수¹ ,고영국¹ ,최동훈¹ ,장양수¹ ,정남식¹ ,최규옥² ,심원흠¹ ,조승연¹ |
Background: The main reason for failure of PCI of CTO is calcified plaque, which either prevents passage of guide wire or is likely to rupture during PCI. MDCT can accurately evaluate location and amount of calcium in occluded segment, as well as occlusion length. We sought to evaluate multiple MDCT-derived parameters which can affect procedural outcome of PCI in CTO patients (pts).
Methods: A total of 39 pts (aged 54.67±9.79 years, 37 males, 42 lesions) who have CTO (duration > 1 month) at least 1 major coronary artery in conventional angiography were studied. All pts underwent 64 MDCT (Somatom Sensation, Siemens, Germany) prior to PCI. The lesions were divided into 2 groups: Group I (PCI-success, 34 lesions) was defined as successful PCI, whereas group II (PCI-failure, 8 lesions) was defined as guide wire passage failure or coronary rupture during PCI. Three calcium-derived parameters in 64-MDCT – regional calcium volume(CaV), regional calcium equivalent mass(CaEq), regional calcium score(CaS) – were calculated by using dedicated software. The clinical characteristics, angiographic, laboratory and MDCT-derived parameters were analysed.
Results: Procedural success rate was 81.0% (34/42 lesions). There were no significant differences of age, male gender, hypertension, diabetes, smoking, history of MI, presence of multi-vessel disease, LVEF and lipid profiles between two groups. The duration of CTO was shorter in group I than group II (months, 2.80±2.59 vs 24.00±21.53, p<0.01). Although statistically not significant, there was a trend toward higher hsCRP in group II than group I (2.2±2.7 vs 3.4±3.3). 64-MDCT derived parameters revealed that the CaV (mm3, 9.05±16.01 vs 99.05±66.36, p<0.01), CaEq (mgCaHA, 2.76±4.61 vs 29.75±15.37, p<0.01), CaS (9.60±17.64 vs 133.22±95.77, p<0.01) in occluded segment was higher in group II than group I. The occlusion length was shorter in group I than group II(mm, 20.68±18.93 vs 45.24±23.80, p<0.01).
Conclusion: Regional calcium scoring can be useful to predict procedural outcome in PCI of CTO. By identifying the length of the CTO segment and quantitatively evaluating amount of calcium, MDCT can be a useful preprocedural tool in PCI of CTO.
|
