Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention.
BACKGROUND
Various scoring systems have been developed to predict the technical outcome and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).


METHODS
We examined the predictive capacity of 3 CTO PCI scores (Clinical and Lesion-related [CL], Multicenter CTO registry in Japan [J-CTO] and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO] scores) in 664 CTO PCIs performed between 2012 and 2016 at 13 US centers.


RESULTS
Technical success was 88% and the retrograde approach was utilized in 41%. Mean CL, J-CTO and PROGRESS CTO scores were 3.9±1.9, 2.6±1.2 and 1.4±1.0, respectively. All scores were inversely associated with technical success (p<0.001 for all) and had moderate discriminatory capacity (area under the curve 0.691 for the CL score, 0.682 for the J-CTO score and 0.647 for the PROGRESS CTO score [p=non-significant for pairwise comparisons]). The difference in technical success between the minimum and maximum CL score strata was the highest (32%, vs. 15% for J-CTO and 18% for PROGRESS CTO scores). All scores tended to perform better in antegrade-only procedures and correlated significantly with procedure time and fluoroscopy dose; the CL score also correlated significantly with contrast utilization.


CONCLUSIONS
CL, J-CTO and PROGRESS CTO scores perform moderately in predicting technical outcome of CTO PCI, with better performance for antegrade-only procedures. All scores correlate with procedure time and fluoroscopy dose, and the CL score also correlates with contrast utilization.
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States.
Aris
A
Karatasakis
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States.
Barbara A
BA
Danek
Columbia University, New York, NY, United States.
Dimitri
D
Karmpaliotis
Henry Ford Hospital, Detroit, MI, United States.
Khaldoon
K
Alaswad
Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Farouc A
FA
Jaffer
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
Robert W
RW
Yeh
VA San Diego Healthcare System and University of California San Diego, La Jolla, CA, United States.
Mitul
M
Patel
VA San Diego Healthcare System and University of California San Diego, La Jolla, CA, United States.
John N
JN
Bahadorani
University of Washington, Seattle, WA, United States.
William L
WL
Lombardi
Torrance Memorial Medical Center, Torrance, CA, United States.
R Michael
RM
Wyman
St. Luke's Mid America Heart Institute, Kansas City, MO, United States.
J Aaron
JA
Grantham
Piedmont Heart Institute, Atlanta, GA, United States.
David E
DE
Kandzari
Piedmont Heart Institute, Atlanta, GA, United States.
Nicholas J
NJ
Lembo
Medical Center of the Rockies, Loveland, CO, United States.
Anthony H
AH
Doing
University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Catalin
C
Toma
Columbia University, New York, NY, United States.
Jeffrey W
JW
Moses
Columbia University, New York, NY, United States.
Ajay J
AJ
Kirtane
Columbia University, New York, NY, United States.
Manish A
MA
Parikh
Columbia University, New York, NY, United States.
Ziad A
ZA
Ali
Minneapolis VA Health Care System and University of Minnesota, Minneapolis, MN, United States.
Santiago
S
Garcia
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States.
Pratik
P
Kalsaria
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States.
Judit
J
Karacsonyi
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States.
Aya J
AJ
Alame
Boston Scientific, Natick, MA, United States.
Craig A
CA
Thompson
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States.
Subhash
S
Banerjee
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: esbrilakis@gmail.com.
Emmanouil S
ES
Brilakis
D000368:Aged; D017023:Coronary Angiography / Q000379:methods / Q000592:standards*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Chronic total occlusion; Complications; Outcomes; Percutaneous coronary intervention; Procedural success; Techniques