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Updated: Jan 10, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Assessment of calcium characteristics in chronic total occlusion using computed tomography coronary angiogram and
Vinoda Sharma1, Ahmed Hassan2, Saba Kouser2
1Department of Cardiology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom; Cardiovascular Science, University of Birmingham, United Kingdom; Cardiovascular Science, Aston University, United Kingdom.
Background:
Calcification in a chronic total occlusion (CTO) is better visualised on Computed Tomography Coronary Angiography (CTCA) than invasive angiography.
Objectives:
The authors sought to assess the characteristics of calcification of a CTO on CTCA and correlate with CTO percutaneous coronary intervention (PCI) outcome.
Methods:
Retrospective analysis of the PCI database was performed (April 2017-April 2024) (clinical trials registration: NCT06414551). Patients who underwent both CTO PCI and CTCA were grouped into successful CTO PCI and any failed attempt of CTO PCI and compared for characteristics of calcification on CTCA: site of calcification, density of calcification in Hounsfield Units (HU) and quantity of calcification in % of cross section of the vessel.
Results:
Out of 499 CTO PCIs performed, 82 patients had undergone CTCA. 51/82 (62.2 %) patients had analysable CTCAs. Mean age was 68.5 (±10.9) years and 19.6 % were female. Patients in the failed group were more likely to have calcification in the proximal cap (failed 65.4 % vs. success 24 %, p = 0.003), more dense calcification in the proximal cap (failed: 611.8 (±517) HU vs. success: 177.6 (±356) HU; p = 0.001) and proximal cap calcification quantity ≥50 % (failed: 75 % vs. success 16.7 %, p = 0.03). Proximal cap calcification ≥50 % was an independent predictor of CTO PCI failure (OR, 3.21, 95 % CI 1.29 to 7.98, p = 0.012).
Conclusions:
Proximal cap calcification density and quantity on CTCA was associated with CTO PCI failure. Assessment of the proximal cap calcification may help with procedure planning in CTO PCI. Larger, prospective multicentre studies are required to corroborate these findings.
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