Author + information
- Matthew Finn1,
- Sanjog Kalra2,
- Ajay Jayant Kirtane3,
- Ziad Ali4,
- Yuanyuan Tang5,
- James Sapontis6,
- John Spertus7,
- Mohammed Qintar8,
- Jeffrey Moses4,
- Manish Parikh4,
- J. Aaron Grantham8 and
- Dimitri Karmpaliotis4
- 1Columbia University Medical Center, New York, New York, United States
- 2Einstein Healthcare Network, Philadelphia, Pennsylvania, United States
- 3Columbia University / New York-Presbyterian Hospital, New York, New Jersey, United States
- 4NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 5Saint Luke's Health System, Kansas City, Missouri, United States
- 6MonashHeart, Victoria, Victoria, Australia
- 7Mid America Heart Institute, Kansas City, Missouri, United States
- 8University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
Clinical and angiographic features in CTO PCI predict procedural difficulty, success, and outcomes. The Japanese CTO (JCTO) score, though widely used, has not consistently predicted success in CTO PCI (validation area under the curve (AUC) 0.76). The PROGRESS CTO score was derived and tested in the same registry (validation AUC 0.72), which may reduce accuracy in other cohorts and with other CTO techniques.
One thousand patients undergoing CTO PCI in the OPEN CTO registry had JCTO and PROGRESS CTO scores modeled to evaluate their ability to predict technical/procedural success. Technical success was defined as adjudicated final TIMI flow≥2 and residual stenosis <50%. Procedural success was defined as technical success without MACCE defined as death, MI, urgent/emergent surgery, stroke, and/or clinical perforation.
Technical and procedural success rates were 86.2% and 81.5%, respectively. Successfully treated patients had a lower incidence of smoking, diabetes, and prior revascularization. The receiver operator analysis (ROC) for technical success demonstrated an AUC of 0.59 vs 0.61 for JCTO scores and PROGRESS CTO scores respectively. The ROC analysis for procedural success demonstrated an AUC of 0.61 for JCTO vs 0.63 for PROGRESS CTO (see figure).
This analysis of a large, multicenter CTO registry demonstrates similar, low-moderate discrimination of technical and procedural success by the JCTO and the PROGRESS CTO scores. This analysis emphasizes the need for validation studies prior to general application of risk scores.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)