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Background—We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography. Methods and Results—A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length ≥15 mm, severe calcification, whole luminal calcification, reattempt, and ≥12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing ≤30 minutes declined consistently from 100% to 0% according to the KCCT score (P<0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics=0.78 versus 0.65–0.72, P<0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of <4 for guidewire crossing ≤30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (P<0.05, all). These results could be reproduced in validation data set (P<0.05, all). Conclusions—KCCT scoring could predict successful guidewire crossing ≤30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Various cardiac diseases show calcifications on CT scans. Their specific anatomic locations may implicate the presence of significant diseases. Calcifications in cardiac valves can be associated with impaired valvular function. Incidental CT detection of a significant amount of coronary artery calcifications may warrant further evaluation. Atrial wall calcifications may suggest previous endocarditis or mural thrombosis. Ventricular wall calcifications can develop after myocardial infarction or trauma and in patients with endomyocardial fibrosis or infectious diseases. In patients with constrictive pericarditis, CT shows pericardial thickening and calcifications. Calcifications can be found in the aorta and pulmonary arteries due to atherosclerosis, Takayasu arteritis, Behçet disease, giant cell aortitis, and other vasculitides of autoimmune or infectious etiology. [ABSTRACT FROM AUTHOR]