title: Comparison of CT-RECTOR and J-CTO scores to predict chronic total occlusion difficulty for percutaneous coronary intervention.
abstract: BACKGROUND
  We sought to evaluate the ability of the CT-RECTOR and J-CTO scores to predict time-efficient guidewire (GW) crossing through a chronic total occlusion (CTO) and final procedure success.
  
  
  METHODS
  Data from 191 consecutive CTO lesions with pre-procedural coronary computed tomography angiography (CCTA) from our center were analyzed retrospectively. The difficulty of the procedure was classified as easy, intermediate, difficult, or very difficult according to CT-RECTOR and J-CTO scores. A successful GW crossing within 30min was set as the first endpoint. Final success of the procedure was set as the second endpoint. Receiver operating characteristic curves and net reclassification improvement (NRI) were used to compare the performance of both scores in predicting both endpoints.
  
  
  RESULTS
  The first and second endpoints were achieved in 55% and 76% of lesions, respectively. The NRI for prediction for both endpoints were 30.21% and 28.94%, respectively. Use of the CT-RECTOR score demonstrated a positive NRI for both the first (p=0.0027) and second (p=0.0190) endpoints. Compared with the J-CTO score (area under the curve: 0.76), the CT-RECTOR score (area under the curve: 0.85) yielded a higher predictive value for successful GW crossing within 30min (p=0.0018).
  
  
  CONCLUSIONS
  Compared with J-CTO, the CT-RECTOR scoring system provides a more accurate noninvasive tool for predicting time-efficient GW crossing and final procedure success. This scoring system, which is based on CCTA, may aid in the identification of very difficult CTO lesions and downstream management.
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China; School of Medicine, Nankai University, China.
authors.forename: Yahang
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China; Department of Cardiology, Tianjin Chest Hospital, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China; Department of Cardiology, SHIJITAN Hospital, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, China.
authors.forename: Luoshan
authors.initials: L
authors.lastname: Du
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Tian
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China.
authors.forename: Lian
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Cao
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, China. Electronic address: yundaichen@yeah.net.
authors.forename: Yundai
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000368:Aged; D002681:China; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D012107:Research Design / Q000592:standards; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: CT-RECTOR; Chronic total occlusion; J-CTO; Percutaneous coronary intervention