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Li T, Yuan D, Wang P, Jia S, Zhang C, Zhu P, Song Y, Tang X, Zhao X, Gao Z, Yang Y, Gao R, Xu B, Yuan J. Associations of lipid measures with total occlusion in patients with established coronary artery disease: a cross-sectional study. Lipids Health Dis 2022; 21:118. [DOI: 10.1186/s12944-022-01733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Total occlusion is the most severe coronary lesion, indicating heavy ischemic burden and poor prognosis. The lipid profile is central to the development of atherosclerotic coronary lesions. Evidence on the optimal lipid measure to be monitored and managed in patients with established coronary artery disease (CAD) is inconclusive.
Methods
Total cholesterol (TC), total triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), nonhigh-density lipoprotein cholesterol (non-HDL-c), lipoprotein (a) [Lp(a)], apolipoprotein B (apoB), non-HDL-c/HDL-c, and apoB/apoA-1 were analyzed in quintiles and as continuous variables. The associations of lipid measures with total occlusion were tested using logistic regression models, visualized with restricted cubic splines, and compared by areas under the receiver operating characteristic curves (AUROC). Discordance analysis was performed when apoB/apoA-1 and non-HDL-c/HDL-c were not in concordance.
Results
The prospective cohort study included 10,003 patients (mean age: 58 years; women: 22.96%), with 1879 patients having total occlusion. The risks of total occlusion significantly increased with quintiles of Lp(a), non-HDL-c/HDL-c, and apoB/apoA-1 (all p for trend < 0.001). TG had no association with total occlusion. Restricted cubic splines indicate significant positive linear relations between the two ratios and total occlusion [odds ratio per 1-standard deviation increase (95% confidence interval): non-HDL-c/HDL-c: 1.135 (1.095–1.176), p < 0.001; apoB/apoA-1: 2.590 (2.049–3.274), p < 0.001]. The AUROCs of apoB/apoA-1 and non-HDL-c/HDL-c were significantly greater than those of single lipid measures. Elevation in the apoB/apoA-1 tertile significantly increased the risk of total occlusion at a given non-HDL-c/HDL-c tertile but not vice versa.
Conclusion
ApoB/apoA-1 confers better predictive power for total occlusion than non-HDL-c/HDL-c and single lipid measures in established CAD patients.
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Yu YT, Sha ZY, Chang SM, Zhai DT, Zhang XJ, Hou AJ, Feng WJ, Li DW, Wang Y, Luan B. Accuracy of the Euro CTO(CASTLE) score obtained on coronary computed tomography angiography for Predicting 30-minute wire crossing in chronic total occlusions. BMC Cardiovasc Disord 2022; 22:184. [PMID: 35439924 PMCID: PMC9019934 DOI: 10.1186/s12872-022-02627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background To investigate the feasibility and accuracy of the Euro CTO (CASTLE)CTA score obtained on coronary computed tomography angiography (CCTA) for predicting the success of percutaneous coronary intervention (PCI) and the 30-min wire crossing in chronic total occlusions (CTO). Method One hundred and fifty patients (154 CTO cases; median age, 61 (interquartile range [IQR], 54–68) years; 75.3% male) received CCTA at the People's Hospital of Liaoning Provincce within 1 month before the procedure. The Euro CTO (CASTLE) score obtained on CCTA(CASTLECTA) was calculated and compared with the Euro CTO (CASTLE) score obtained based on coronary angiography (CASTLECAG) for the predictive value of 30-min wire crossing and CTO procedural success. Results In our study, the CTO-PCI success rate was 89.0%, with guidewires of 65 cases (42.2%) crossing within 30 min. There were no significant differences in the median CASTLECTA and CASTLECAG scores in the procedure success group (3 [IQR, 2–4] vs 3 (IQR, 2–3]; p = 0.126). However, the median CASTLECTA score was significantly higher than the median CASTLECAG score in the procedure failure group (4 [IQR, 3–5.5] vs 4 [IQR, 2.5–5.5]; p = 0.021). There was no significant difference between the median CASTLECTA score and the median CASTLECAG score in the 30-min wire crossing failure group (3 [IQR, 3–4] vs 3 [IQR, 2–4]; p = 0.254). However, the median CASTLECTA score was significantly higher than the median CASTLECAG score in the 30-min wire crossing group (3 [IQR, 2–3] vs 2 [IQR, 2–3]; p < 0.001). The CASTLECTA score described higher levels of calcification than the CASTLECAG score (48.1% vs 33.8%; p = 0.015). There was no significant difference between the CASTLECTA score (area under the curve [AUC], 0.643; 95% confidence interval [CI], 0.561–0.718) and the CASTLECAG score (AUC, 0.685; 95% CI, 0.606–0.758) for predicting procedural success (p = 0.488). The CASTLECTA score (AUC, 0.744; 95% CI, 0.667–0.811) was significantly better than the CASTLECAG score (AUC, 0.681; 95% CI, 0.601–0.754; p = 0.046) for predicting 30-min wire crossing with the best cut-off value being CASTLECTA ≤ 3. The sensitivity, specificity, positive predictive value, and negative predictive value were 90.8%, 55.2%, 54.6%, and 87.0%, respectively. Conclusion The CASTLECTA scores obtained from noninvasive CCTA perform better for the prediction of the 30-min wire crossing than the CASTLECAG score.
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Affiliation(s)
- Yan-Tan Yu
- School of Graduate, Dalian Medical University, Lushunkou District, No. 9, West Section of Lushun South Road, Dalian, 116041, China
| | - Zhi-Yi Sha
- Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Shu-Min Chang
- School of Graduate, Dalian Medical University, Lushunkou District, No. 9, West Section of Lushun South Road, Dalian, 116041, China
| | - Du-Tian Zhai
- Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Xiao-Jiao Zhang
- Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Ai-Jie Hou
- Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Wen-Jie Feng
- Department of Radiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Dao-Wei Li
- Department of Radiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Yong Wang
- Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China.
| | - Bo Luan
- Department of Cardiology, The People's Hospital of China Medical University, People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang, 110000, China.
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Opolski MP, Nap A, Knaapen P. A computed tomography algorithm for crossing coronary chronic total occlusions: riding on the wave of the proximal cap and distal vessel segment. Neth Heart J 2020; 29:42-51. [PMID: 33175332 PMCID: PMC7782599 DOI: 10.1007/s12471-020-01510-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 01/21/2023] Open
Abstract
With wider adoption of coronary computed tomography angiography (coronary CTA), chronic total occlusions (CTOs) are being increasingly identified and characterised by non-invasive angiography. In particular, the ability of coronary CTA to clearly delineate atherosclerotic plaque, as well as to display three-dimensional vessel trajectories, has garnered particular attention in the context of preprocedural planning and periprocedural guidance of CTO percutaneous coronary intervention (PCI). Single CTO features and combined scoring systems derived from CTA (mostly exceeding the diagnostic performance of the angiographic J‑CTO score) have been used to predict time-efficient guidewire crossing, and thus grade the CTO difficulty level prior to PCI. In addition, the introduction of three-dimensional CTA/fluoroscopy co-registration for periprocedural navigation during CTO PCI offers the unprecedented opportunity to resolve proximal cap ambiguity and clearly visualise the distal CTO segment, thereby potentially influencing CTO PCI strategies and techniques. In this review, the potential advantages of non-invasive evaluation of CTO by coronary CTA are described, and a CTA-based hybrid algorithm is introduced for further enhancing the efficiency of CTO PCI. Further studies are clearly needed to verify the proposed approach. However, several luminary operators have already implemented coronary CTA for planning and periprocedural guidance of CTO interventions using the hybrid algorithm.
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Affiliation(s)
- M P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
| | - A Nap
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - P Knaapen
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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