Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Diagnostics

Background:

• Differentiating total occlusions (TOs) from severe stenoses in coronary arteries using coronary computed tomography angiography (CCTA) is crucial but challenging.
• The role of quantitative assessment in CCTA for distinguishing TOs from severe stenoses requires further investigation.

Purpose of the Study:

• To determine if quantitative CCTA characteristics can differentiate TOs from severe stenoses as confirmed by invasive coronary angiography (ICA).

Main Methods:

• A sub-analysis of the FASTTRACK CABG trial (NCT04142021) involving patients with both CCTA and ICA.
• Semi-automated CCTA plaque-analysis software was used for quantitative analysis.
• Blinded analysts compared TOs on CCTA with corresponding ICA findings.

Main Results:

• Eighty-four TOs were identified in 59 patients; concordance between ICA and CCTA for TO diagnosis was 56.0%.
• TOs exhibited significantly longer lesion length (25.1 mm vs. 9.4 mm) and higher dense calcium percentage atheroma volume compared to severe stenoses.
• A lesion length >5.5 mm (AUC 0.77) was the optimal cutoff for differentiating TOs from severe stenoses, showing 91.1% sensitivity and 61.1% specificity.

Conclusions:

• Quantitative CCTA analysis, specifically lesion length, is a valuable tool for differentiating TOs from severe stenoses.
• A lesion length exceeding 5.5 mm emerged as the sole independent predictor for identifying TOs on CCTA.