Author + information
- Cai De Jin1,2,
- Moo Hyun Kim1,2,
- Kwang Min Lee2,
- Tae Hyung Kim2,
- Young-Rak Cho1 and
- Victor Serebruany3
The optimal strategies to manage chronic total occlusion (CTO) are unclear. The J-CTO score (multicenter CTO registry in Japan) is an established assessment tool for predicting successful recanalization. Whether it is suitable and applicable for Korean patients remains uncertain. Therefore, novel CTO scoring model combining clinical and angiographic characteristics may offer clinical advantage for Koreans. We designed and tested a scoring model for the prediction of successful CTO recanalization in a single hospital setting.
The CTO patients (n=438) underwent coronary intervention were eligible then analyzed. CTO opening was set as the primary endpoint regardless of interventional era and operator bias. The B-CTO (Busan Single-center CTO Registry) scoring model was designed, and later determined by predictors, which were associated with study endpoint. Six independent predictors were selected into derivate B-CTO scoring system: age 60-74 years, lesion length ≥20 mm (assigned 1 point each), age ≥75 years, female gender, lesion located in right coronary artery, blunt stump and bending >45° (2 points each). For each predictor assigned point was based on odds ratio in multivariate analysis. Then, we classified the lesions into 4 groups according to the summation of score points, easy (score 0-1), intermediate (score 2-3), difficult (score 4-5) and very difficult (score ≥6) to access the probability of successful CTO recanalization.
Final technique success rate was achieved 81.1%. The probability of successful recanalization for easy (n=64), intermediate (n=148), difficult (n=134) and very difficult (n=92) groups was 95.3%, 86.5%, 79.1% and 65.2%, respectively (p for trend <0.001). Compared to J-CTO scoring model, the B-CTO scoring model significantly improved discrimination as indicated by the area under the receiver-operator characteristic curve (▵AUC: 0.083; 95% CI: 0.025-0.141) with positive integrated discrimination improvement of 0.042, and the net reclassification improvement of 56.0%.
Novel B-CTO score model designed and tested specifically in Korean patients with native coronary CTO is suitable for predicting the probability of successful recanalization.