title: Clinical Utility of the Japan-Chronic Total Occlusion Score in Coronary Chronic Total Occlusion Interventions: Results from a Multicenter Registry.
abstract: BACKGROUND
  The performance of the Japan-chronic total occlusion (J-CTO) score in predicting success and efficiency of CTO percutaneous coronary intervention has received limited study.
  
  
  RESULTS
  We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2011 and 2014 at 6 experienced centers in the United States. Six hundred and fifty-seven lesions were classified as easy (J-CTO=0), intermediate (J-CTO=1), difficult (J-CTO=2), and very difficult (J-CTO≥3). The impact of the J-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression, respectively. The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves. Antegrade wiring techniques were used more frequently in easy lesions (97%) than very difficult lesions (58%), whereas the retrograde approach became more frequent with increased lesion difficulty (41% for very difficult lesions versus 13% for easy lesions). The logistic regression model for technical success demonstrated satisfactory calibration and discrimination (P for Hosmer-Lemeshow =0.743 and area under curve =0.705). The J-CTO score was associated with a 2-fold increase in the odds of technical failure (odds ratio 2.04, 95% confidence interval 1.52-2.80, P<0.001). Procedure time increased by ≈20 minutes for every 1-point increase of the J-CTO score (regression coefficient 22.33, 95% confidence interval 17.45-27.22, P<0.001).
  
  
  CONCLUSIONS
  J-CTO score was strongly associated with final success and efficiency in this study, supporting its expanded use in CTO interventions.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: William
authors.initials: W
authors.lastname: Lombardi
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Daisha J
authors.initials: DJ
authors.lastname: Cipher
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Megan A
authors.initials: MA
authors.lastname: Kypreos
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: David
authors.initials: D
authors.lastname: Kandzari
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.). esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000145:classification*; D005260:Female; D005544:Forecasting; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D016896:Treatment Outcome
keywords: J-CTO score; chronic total occlusion; complication; outcome; percutaneous coronary intervention; radiation