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<p>Coronary calcium significantly increases complexity in chronic total occlusion percutaneous coronary intervention (CTO-PCI). Coronary computed tomography angiography (CCTA) enables precise CTO assessment. However, no prior study has proposed a CCTA–based morphological classification of calcium patterns and assessed its procedural impact. To propose and validate a novel seven-point CCTA-derived classification of calcium morphology, ranging from “spot” (≤ 10% cross-sectional area, CSA) to “full moon” (100% CSA). We retrospectively included 167 patients undergoing CTO-PCI with prior CCTA. The primary endpoint was procedural failure. Secondary endpoints included coronary perforations, procedural and fluoroscopic time, and number of guidewires and balloons. A progressive, stepwise increase in procedural failure (from 6.2% in spot to 26.7% in full moon lesions; <i>p</i> = 0.007) and coronary perforation rates (from 3.1% in spot to 13.3% in full moon lesions; <i>p</i> = 0.03) was observed across the seven identified calcium patterns. In multivariable analysis, calcium severity was independently associated with procedural failure (OR 1.2 per step; 95% CI 1.01–1.52; <i>p</i> = 0.04). Increasing calcium severity was also independently associated with procedural time (<i>B</i> =  + 4.7&#xa0;min/step; <i>p</i> = 0.03), fluoroscopic time (<i>B</i> =  + 2.2&#xa0;min/step; <i>p</i> = 0.04), number of guidewires (<i>B</i> =  + 0.30/step; <i>p</i> = 0.03) and balloons (<i>B</i> =  + 0.31/step; <i>p</i> = 0.005). Full-scale progression from “spot” to “full moon” corresponded to + 33&#xa0;min increase in procedural and + 14&#xa0;min in fluoroscopic time. A novel CCTA-based calcium classification showed a strong, independent association with procedural failure and complexity. Its reproducibility and integration potential make it a valuable tool for enhancing planning and safety in CTO-PCI.</p> Graphical abstract <p></p>

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Impact of coronary calcium patterns on procedural outcomes in CTO-PCI: a computed tomography-based multicenter study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月11日

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  • Giuseppe Panuccio,
  • Gerald S. Werner,
  • Salvatore De Rosa,
  • Daniele Torella,
  • Yasuhiro Ichibori,
  • Nicole Carabetta,
  • Carsten Skurk,
  • Patrick T. Siegrist,
  • David M. Leistner,
  • Ömer Göktekin,
  • Kambis Mashayekhi,
  • Ulf Landmesser,
  • Youssef S. Abdelwahed

摘要

Coronary calcium significantly increases complexity in chronic total occlusion percutaneous coronary intervention (CTO-PCI). Coronary computed tomography angiography (CCTA) enables precise CTO assessment. However, no prior study has proposed a CCTA–based morphological classification of calcium patterns and assessed its procedural impact. To propose and validate a novel seven-point CCTA-derived classification of calcium morphology, ranging from “spot” (≤ 10% cross-sectional area, CSA) to “full moon” (100% CSA). We retrospectively included 167 patients undergoing CTO-PCI with prior CCTA. The primary endpoint was procedural failure. Secondary endpoints included coronary perforations, procedural and fluoroscopic time, and number of guidewires and balloons. A progressive, stepwise increase in procedural failure (from 6.2% in spot to 26.7% in full moon lesions; p = 0.007) and coronary perforation rates (from 3.1% in spot to 13.3% in full moon lesions; p = 0.03) was observed across the seven identified calcium patterns. In multivariable analysis, calcium severity was independently associated with procedural failure (OR 1.2 per step; 95% CI 1.01–1.52; p = 0.04). Increasing calcium severity was also independently associated with procedural time (B =  + 4.7 min/step; p = 0.03), fluoroscopic time (B =  + 2.2 min/step; p = 0.04), number of guidewires (B =  + 0.30/step; p = 0.03) and balloons (B =  + 0.31/step; p = 0.005). Full-scale progression from “spot” to “full moon” corresponded to + 33 min increase in procedural and + 14 min in fluoroscopic time. A novel CCTA-based calcium classification showed a strong, independent association with procedural failure and complexity. Its reproducibility and integration potential make it a valuable tool for enhancing planning and safety in CTO-PCI.

Graphical abstract