title: Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score.
abstract: OBJECTIVE
  This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach.
  
  
  BACKGROUND
  Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning.
  
  
  METHODS
  We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort.
  
  
  RESULTS
  Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144).
  
  
  CONCLUSIONS
  The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach.
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Columbia University, New York, New York.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Torrance Memorial Medical Center, Torrance, California.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Wyman
authors.affiliation: Appleton Medical Center, Appleton, Wisconsin.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: William
authors.initials: W
authors.lastname: Lombardi
authors.affiliation: Mid America Heart Institute, Kansas City, Missouri.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Columbia University, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christakopoulos
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Muhammad Nauman J
authors.initials: MNJ
authors.lastname: Tarar
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: Minneapolis VA Medical Center, Minneapolis, Minnesota.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: College of Health Innovation, University of Texas at Arlington, Arlington, Texas.
authors.forename: Daisha
authors.initials: D
authors.lastname: Cipher
authors.affiliation: Boston Scientific, Natick, Massachusetts.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: chronic total occlusion; percutaneous coronary intervention; scoring; technical success