Percutaneous Coronary Intervention for Chronic Total Occlusions: Predictors for Coronary Perforation and Dissection Evaluated with 64-Multislice Computed Tomography

Background: This study aimed to determine the predictors for coronary complications during angioplasty for chronic total occlusion (CTO) based on results of 64-multislice computed tomography (MSCT). Methods: In this study, 67 patients with 82 de novo CTO lesions were assessed with 64-MSCT before undergoing percutaneous coronary interventions (PCIs). All CTO lesions were individually analyzed according to the occurrence of complication. Complication during intervention was defined as a coronary perforation or long dissection (length > 10 mm). Results: The technical and procedural success rates for PCI in CTO were 89.0% and 80.5%, respectively. The average age in the complication group was slightly older than in the noncomplication group (69.8 +/- 8.2 vs. 63.6 +/- 11.9 p=0.053). In addition, there were more female patients and fewer smoking patients in the complication group than in the noncomplication group (p = 0.002 and p = 0.007, respectively). There were significant differences in heavy calcification with a calcification length ratio > 0.5, proximal stump calcification, distal stump calcification, and the number of calcification plaques between the complication and noncomplication group (p = 0.003, p = 0.009, p = 0.002, and p < 0.001, respectively). Furthermore, there was a trend toward more ostial lesions in the complication group than in the noncomplication group (p = 0.052). The technical and procedural Success rates were significantly different in the complication group versus the noncomplication group (62.5% vs. 95.5%; 25.0% vs. 93.9%, respectively; p < 0.001 for both). Multivariate analysis showed that heavy calcification was the only independent parameter (odds ratio [OR] = 6.332, 95% confidence interval [CI] = 1.436-27.916, p = 0.015). Conclusion: A calcification length ratio > 0.5 was independently predictive of mechanical complication during PCI for CTO.