Background: Despite of increasing utilization of coronary CT angiography (CCTA) before percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), the role of CCTA on the procedural outcome has not been reported in a large-scaled study. We investigated the impact of pre-procedural CCTA on the procedural success of CTO PCI on a patient-basis.

Methods: We studied procedural data from 3436 patients (age 62.9 +/-11.2 year, male gender 74%) enrolled in e-CTO multicenter registry.

Results: Pre-procedural CCTA was performed in 19% (N=653, CCTA group). CCTA groups were slightly but significantly younger (62.1+/-10.6 versus 63.1+/-11.3 year, p=0.034) and showed higher frequency of male gender (78% vs 73%, p=0.009) than non-CCTA group. The overall procedural success was lower in CCTA group than non-CCTA group (75.3% vs. 83.3%, p<0.0001). The lower procedural success rate of CCTA group compared to non-CCTA group was consistent in subgroup analyses by lesion location (LAD, 78.4% vs. 85.7%, p=0.005; LCX, 84.3% vs. 72.5%, p=0.007; RCA, 80.5% vs. 73.3%, p=0.010) or by lesion length (length > 20 mm, 76.4% vs. 86.3%, p=0.001; length <= 20mm, 81.8% vs. 74.8%, p=0.001).

Conclusions: In this large-scaled multicenter registry, pre-procedural CCTA did not show beneficial impact on the procedural success of CTO PCI. Although our study is not free from potential selection bias of doing CCTA for challenging CTO lesion, the routine CCTA before CTO PCI cannot be recommended based on our results. Careful case selection or sophisticated CCTA analytic methods would be required to demonstrate the clinical role of pre-procedural CCTA before CTO PCI.