TCT CONNECT-229 Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Intervention: Comparison of 3 Scores
Karacsonyi J, Stanberry L, Alaswad K, Krestyaninov O, Choi J, Rangan B, Nikolakopoulos I, Vemmou E, Ungi I, and Brilakis E. TCT CONNECT-229 Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Intervention: Comparison of 3 Scores. Journal of the American College of Cardiology 2020; 76(17):B100-B101.
Journal of the American College of Cardiology
Background: Several scoring systems were developed to assess procedural difficulty: Japan chronic total occlusion (J-CTO) the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO) and the prior Coronary artery bypass graft surgery, Age, Stump anatomy, Tortuosity degree, Length of occlusion and Extent of calcification (EuroCTO CASTLE) score. We thought to compare 3 CTO percutaneous coronary intervention (PCI) scores for predicting technical success.
Methods: We compared the three scores for predicting technical success in 3,757 CTO PCIs enrolled in the PROGRESS-CTO Registry between 2016 and 2020 at 30 centers.
Results: The technical and procedural success rates were 84.9% and 82.7%, respectively. Major cardiac adverse events occurred in 1.73%. The mean scores were as follows: J-CTO: 2.40 ± 1.30, PROGRESS-CTO: 1.28 ± 1.02, and CASTLE: 2.05 ± 1.33. All the 3 scores performed moderately well: in the score only model the J-CTO score showed the highest discriminatory capacity (area under the curve [AUC]: 0.77, 95% confidence interval [CI]: 0.75 to 0.79), followed by the CASTLE (AUC: 0.76, 95% CI: 0.69 to 0.73, p = 0.05 vs. J-CTO) and the PROGRESS-CTO score (AUC: 0.71, 95% CI: 0.74 to 0.78, p < 0.001 vs. J-CTO and CASTLE). The 3 scores had similar sensitivity and specificity, except for slightly lower specificity for PROGRESS score that contains only angiographic characteristics and includes the fewest variables. [Formula presented]
Conclusion: The 3 scores perform moderately well in predicting the technical success of CTO PCI with the J-CTO score having the best overall performance. CTO PCI scores can be very useful for periprocedural planning and risk-benefit assessment in contemporary practice.
Categories CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)