title: Coronary computed tomographic prediction rule for time-efficient guidewire crossing through chronic total occlusion: insights from the CT-RECTOR multicenter registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization).
abstract: OBJECTIVE
  This study sought to establish a coronary computed tomography angiography prediction rule for grading chronic total occlusion (CTO) difficulty for percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The uncertainty of procedural outcome remains the strongest barrier to PCI in CTO.
  
  
  METHODS
  Data from 4 centers involving 240 consecutive CTO lesions with pre-procedural coronary computed tomography angiography were analyzed. Successful guidewire (GW) crossing ≤30 min was set as an endpoint to eliminate operator bias. The CT-RECTOR (Computed Tomography Registry of Chronic Total Occlusion Revascularization) score was developed by assigning 1 point for each independent predictor, and then summing all points accrued. Continuous distribution of scores was used to stratify CTO into 4 difficulty groups: easy (score 0); intermediate (score 1); difficult (score 2); and very difficult (score ≥3). Discriminatory performance was tested by 10-fold cross-validation and compared with the angiographic J-CTO (Multicenter CTO Registry of Japan) score.
  
  
  RESULTS
  Study endpoint was achieved in 55% of cases. Multivariable analysis yielded multiple occlusions, blunt stump, severe calcification, bending, duration of CTO ≥12 months, and previously failed PCI as independent predictors for GW crossing. The probability of successful GW crossing ≤30 min for each group (from easy to very difficult) was 95%, 88%, 57%, and 22%, respectively. Areas under receiver-operator characteristic curves for the CT-RECTOR and J-CTO scores were 0.83 and 0.71, respectively (p < 0.001). Both the original model fit and 10-fold cross-validation correctly classified 77.3% of lesions.
  
  
  CONCLUSIONS
  The CT-RECTOR score represents a simple and accurate noninvasive tool for predicting time-efficient GW crossing that may aid in grading CTO difficulty before PCI. (Computed Tomography Angiography Prediction Score for Percutaneous Revascularization for Chronic Total Occlusions [CT-RECTOR]; NCT02022878).
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: opolski.mp@gmail.com.
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.affiliation: Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Schuhbäck
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Department of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
authors.affiliation: Department of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.affiliation: Department of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Renker
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Walther
authors.affiliation: Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlundt
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Debski
authors.affiliation: Institute of Econometrics, Warsaw School of Economics, Warsaw, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Jakubczyk
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D012042:Registries; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: chronic total occlusion; clinical prediction rule; coronary computed tomography angiography; percutaneous coronary intervention