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Introduction Calcified coronary arteries pose a challenge to percutaneous coronary intervention (PCI). Calcium modification techniques (CMTs) increase procedural length, complexity and risk. Computed tomography coronary angiography (CTCA) is well suited to calcium identification and quantification and may offer valuable pre-procedural information. We hypothesised that CTCA could predict cases where CMT would be required during PCI. Methods A retrospective review (2021/2022) of consecutive patients who underwent CTCA and subsequent PCI to a calcified lesion. Blinded to the PCI strategy CTCA images were re-reviewed by expert CT readers and calcium thickness, length, density and circumferential arc quantified. Receiver operating characteristic (ROC) curves and optimum cut-off values were calculated. Calcium density (>1000 HU) and calcific arc (>180°) were proposed as a calcium planning score (CPS CTCA), with 1 point assigned per criteria met. Results 76 PCI procedures were included (72 patients). CMT was used in 53% at the discretion of the operator. On CTCA calcific arc, density, length and thickness had an area under the curve (AUC) of 0.74, 0.7, 0.67 and 0.63 respectively. There was a step-wise increase in the proportion of cases requiring CMT with increasing CPS CTCA. 0 vs 1 point; OR 9 (1.1–82, p=.04), RR 5 (0.8–36, p=.09), 1 vs 2 points; OR 3.2 (1.1–9.3, p=.03), RR 1.6 (1–2.3, p=.04), 0 vs 2 points; OR 30 (3.3–272, p=.003), RR of 8 (1.3–54, p=.03). Conclusions The incorporation of CTCA measured calcium density >1000 HU and calcium arc >180° into a calcium planning score may help with predicting the need for CMT at the time of PCI, enhancing both procedural planning and the consent process. Conflict of Interest None
Murphy et al. (Mon,) studied this question.