title: Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score.
abstract: High success rates are achievable for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the hybrid approach, but periprocedural complications remain of concern. Although scores estimating success and efficiency in CTO PCI have been developed, there is currently no available score for estimation of the risk for periprocedural complications. We sought to develop a scoring tool for prediction of periprocedural complications during CTO PCI.
  
  
  
  We analyzed data from 1569 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) using a derivation and validation sampling ratio of 2:1. Variables independently associated with periprocedural complications in multivariable analysis in the derivation set were assigned points based on their respective odds ratios. Forty-four (2.8%) patients experienced complications. Three factors were independent predictors of complications and were included in the score: patient age >65 years, +3 points (odds ratio, OR=4.85, CI 1.82-16.77); lesion length ≥23 mm, +2 points (OR=3.22, CI 1.08-13.89); and use of the retrograde approach +1 point (OR=2.41, CI 1.04-6.05). The resulting score showed good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow χ26.271, P=0.281, receiver-operating characteristic [ROC] area=0.758) and validation (Hosmer-Lemeshow χ24.551, P=0.473, ROC area=0.793) sets. Score values of 0 to 2, 3 to 4, and ≥5 were defined as low, intermediate, and high risk of complications (derivation cohort 0.4%, 1.8%, 6.5%, P<0.001; validation cohort 0.0%, 2.5%, 6.8%, P<0.001).
  
  
  
  The PROGRESS CTO complication score is a useful tool for prediction of periprocedural complications in CTO PCI.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Barbara Anna
authors.initials: BA
authors.lastname: Danek
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: Columbia University, New York, NY.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Henry Ford Hospital, Detroit, MI.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, CA.
authors.forename: Mitul P
authors.initials: MP
authors.lastname: Patel
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, CA.
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Torrance Memorial Medical Center, Torrance, CA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Wyman
authors.affiliation: Mid America Heart Institute, Kansas City, MO.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Medical Center of the Rockies, Loveland, CO.
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.affiliation: Piedmont Heart Institute, Atlanta, GA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Piedmont Heart Institute, Atlanta, GA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Lembo
authors.affiliation: Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.affiliation: Columbia University, New York, NY.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Columbia University, New York, NY.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Columbia University, New York, NY.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: Columbia University, New York, NY.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Boston Scientific, Natick, MA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment
keywords: chronic total occlusion; complication; outcome; percutaneous coronary intervention; risk stratification