Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Intervention

HomeCirculation: Cardiovascular InterventionsVol. 14, No. 1Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Intervention Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBPredicting InterventionComparison 3 Scores Judit Karacsonyi, MD, PhD, Larissa Stanberry, Khaldoon Alaswad, Oleg Krestyaninov, James W. Choi, Bavana V. Rangan, BDS, MPH, Ilias Nikolakopoulos, Evangelia Vemmou, Imre Ungi, PhD and Emmanouil S. Brilakis, KaracsonyiJudit Karacsonyi Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.K., L.S., B.V.R., I.N., E.V., E.S.B.). Division Invasive Cardiology, Second Department Internal Medicine Cardiology Center, University Szeged, Hungary I.U.). Search for more papers by this author , StanberryLarissa Stanberry AlaswadKhaldoon Alaswad Henry Ford Detroit, MI (K.A.). KrestyaninovOleg Krestyaninov Meshalkin Novosibirsk Research Institute, Russia (O.K.). ChoiJames Choi Baylor Vascular Dallas, TX (J.W.C.). RanganBavana Rangan NikolakopoulosIlias Nikolakopoulos VemmouEvangelia Vemmou https://orcid.org/0000-0003-3286-6610 UngiImre Ungi BrilakisEmmanouil Brilakis Correspondence to: 920 E 28th St 300, Minneapolis, 55407. Email E-mail Address: [email protected] https://orcid.org/0000-0001-9416-9701 Originally published11 Jan 2021https://doi.org/10.1161/CIRCINTERVENTIONS.120.009860Circulation: Interventions. 2021;14:e009860Other version(s) articleYou are viewing the most recent version article. Previous versions: January 11, 2021: Ahead Print The success chronic total occlusion (CTO) percutaneous coronary intervention (PCI) significantly increased from 77% between 2000 20111 85% 90% currently at experienced centers depends on center operator experience lesion characteristics. Several CTO PCI scoring systems have been developed assess procedural difficulty. first one was Japan (J-CTO) score that estimates likelihood successful guidewire crossing within 30 minutes based 5 variables: blunt stump, calcification, tortuosity, prior failed attempt, length ≥20 mm.2 Another widely used is Prospective Global Registry Study (PROGRESS-CTO) uses 4 angiographic characteristics: moderate/severe proximal vessel cap ambiguity, circumflex artery CTO, absence interventional collaterals predict technical success.3 EuroCTO CASTLE utilizes 6 variables assessing success: bypass graft surgery, age (≥70 years), stump anatomy (blunt or invisible), tortuosity degree (severe unseen), (≥20 mm), extent calcification (>50% segment).4We compared aforementioned scores predicting in 3757 PCIs performed patients enrolled PROGRESS-CTO (REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02061436) 2016 2020 27 US international centers. study approved institutional review board each site. cases derive PROGRESS were excluded analyses. data will not be made publicly available.Mean 64.1±10 years, men (81%), 41% had history diabetes, 28% a 30% congestive heart failure. common target right (53%), followed left anterior descending (27%), (20%). 84.9% 82.7%, respectively incidence major cardiac adverse events 1.73%. mean as follows: J-CTO: 2.40±1.30, PROGRESS-CTO: 1.28±1.02, CASTLE: 2.05±1.33. lower higher values all (Figure [A]). discriminatory performance evaluated comparing areas under receiver characteristics curves [B]) multivariable models [C]). using nonparametric approach DeLong et al.5 All moderately well: score, only model J-CTO demonstrated highest capacity (areas curve, 0.77 [95% CI, 0.75–0.79]), 0.76 0.74–0.78]; P=0.05 versus score) 0.71 0.69–0.73], P<0.001 scores). which contains includes fewest slightly specificity.Download figureDownload PowerPointFigure. (ROC) curve analyses scores.A, across (J-CTO), (PROGRESS-CTO), strata. B, ROC risk alone CASTLE, J-CTO, scores. C, multivariate score: age, anatomy, degree, occlusion, calcification. AUC indicates area curve; FPR, false positive rate; TPR, true rate.The main finding our PROGRESS-CTO, perform well with having best overall performance. can very useful periprocedural planning risk-benefit assessment contemporary practice.Our has limitations. First, it an observational, retrospective study. Second, there no clinical event adjudication committee. Third, procedures high-volume, centers, limiting generalizability findings nonexpert centers.Nonstandard Abbreviations AcronymsCTOchronic occlusionJ-CTOJapan occlusionPCIpercutaneous interventionPROGRESS-CTOProspective InterventionAcknowledgmentsStudy collected managed Electronic Data Capture (REDCap) electronic capture tools hosted Foundation (MHIF), Minnesota.Sources FundingThis article received Hospital Innovation Grant Gift Joseph F. Mary M. Fleischhacker Foundation.Disclosures Dr consulting fees Terumo Boston Scientific; consultant (nonfinancial) Laboratories. consulting/speaker honoraria Vascular, American Association (associate editor Circulation), Amgen, Biotronik, Scientific, Innovations (Board Directors), CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, Teleflex; research support Regeneron Siemens. He shareholder MHI Ventures. other authors report conflicts.FootnotesFor Sources Funding Disclosures, see page 108.Correspondence protected]comReferences1. Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, Alomar M, Shorrock D, Cipher Abdullah S, al.. Angiographic complications undergoing interventions: weighted meta-analysis 18,061 65 studies.JACC Cardiovasc Interv. 2013; 6:128–136. doi: 10.1016/j.jcin.2012.10.011CrossrefMedlineGoogle Scholar2. Morino Y, Abe Morimoto T, Kimura Hayashi Muramatsu Ochiai Noguchi Kato K, Shibata al.; Investigators. Predicting through native lesions minutes: (Multicenter Japan) Score difficulty grading time tool.JACC 2011; 4:213–221. 10.1016/j.jcin.2010.09.024CrossrefMedlineGoogle Scholar3. Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis Wyman MR, Lombardi W, Grantham JA, Moses J, Development validation novel system (Prospective Intervention) Score.JACC 2016; 9:1–9. 10.1016/j.jcin.2015.09.022CrossrefMedlineGoogle Scholar4. Szijgyarto Z, Rampat R, Werner GS, Ho Reifart Lefevre Louvard Avran Kambis Buettner HJ, Derivation 20,000-Patient Registry: (CASTLE) 2019; 12:335–342. 10.1016/j.jcin.2018.11.020CrossrefMedlineGoogle Scholar5. ER, DM, Clarke-Pearson DL. Comparing two correlated operating characteristic curves: approach.Biometrics. 1988; 44:837–845.CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetailsCited BySimsek Kostantinis J (2022) Intervention: A Window Future?, Journal Association, 11:10, Online publication date: 17-May-2022. Assali Buda Megaly Hall Burke M (2021) Update intervention, Progress Diseases, 10.1016/j.pcad.2021.11.004, 69, (27-34), 1-Nov-2021. 2021Vol Issue 1Article InformationMetrics © Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.120.009860PMID: 33423537 publishedJanuary 2021 Keywordscoronary bypassincidencepercutaneous interventionregistriesheart failurePDF download Advertisement SubjectsCatheter-Based Valvular InterventionsPercutaneous InterventionRevascularization