Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic difficulty scores in the PROGRESS-CTO registry

Deniz Mutlu; Bahadir Simsek; Athanasios Rempakos; Michaella Alexandrou; Ahmed Al-Ogaili; Lorenzo Azzalini; Stephane Rinfret; Jaikirshan J Khatri; Khaldoon Alaswad; Farouc A Jaffer; Wissam Jaber; Mir B Basir; Omer Goktekin; Sevket Gorgulu; Oleg Krestyaninov; Dmitrii Khelimskii; Rhian Davies; Jarrod Frizzel; James W Choi; Raj H Chandwaney; Srinivasa Potluri; Paul Poommipanit; Barry Uretsky; Luiz F Ybarra; Bilal Murad; Bavana V Rangan; Olga C Mastrodemos; Yader Sandoval; M Nicholas Burke; Emmanouil S Brilakis

doi:10.1016/j.carrev.2024.10.007

Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic difficulty scores in the PROGRESS-CTO registry

Cardiovasc Revasc Med. 2024 Oct 28:S1553-8389(24)00705-X. doi: 10.1016/j.carrev.2024.10.007. Online ahead of print.

Authors

Deniz Mutlu¹, Bahadir Simsek², Athanasios Rempakos¹, Michaella Alexandrou¹, Ahmed Al-Ogaili¹, Lorenzo Azzalini³, Stephane Rinfret⁴, Jaikirshan J Khatri⁵, Khaldoon Alaswad⁶, Farouc A Jaffer⁷, Wissam Jaber⁴, Mir B Basir⁶, Omer Goktekin⁸, Sevket Gorgulu⁹, Oleg Krestyaninov¹⁰, Dmitrii Khelimskii¹⁰, Rhian Davies¹¹, Jarrod Frizzel¹², James W Choi¹³, Raj H Chandwaney¹⁴, Srinivasa Potluri¹⁵, Paul Poommipanit¹⁶, Barry Uretsky¹⁷, Luiz F Ybarra¹⁸, Bilal Murad¹, Bavana V Rangan¹, Olga C Mastrodemos¹, Yader Sandoval¹, M Nicholas Burke¹, Emmanouil S Brilakis¹⁹

Affiliations

¹ Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
² Yale University, School of Medicine, Department of Internal Medicine, New Haven, CT, USA.
³ University of Washington, Seattle, WA, USA.
⁴ Emory University Hospital Midtown, Atlanta, GA, USA.
⁵ Cleveland Clinic, Cleveland, OH, USA.
⁶ Henry Ford Cardiovascular Division, Detroit, MI, USA.
⁷ Massachusetts General Hospital, Boston, MA, USA.
⁸ Memorial Bahcelievler Hospital, Istanbul, Turkey.
⁹ Biruni University Medical School, Istanbul, Turkey.
¹⁰ Meshalkin National Research Institute, Novosibirsk, Russian Federation.
¹¹ WellSpan York Hospital, York, PA, USA.
¹² The Christ Hospital, Cincinnati, OH, USA.
¹³ Texas Health Presbyterian Dallas Hospital and Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA.
¹⁴ Oklahoma Heart Institute, Tulsa, OK, USA.
¹⁵ The Heart Hospital Baylor Plano, Plano, TX, USA.
¹⁶ University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
¹⁷ Central Arkansas Veterans Health System, and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
¹⁸ Western University, London Health Sciences Center, London, ON, Canada.
¹⁹ Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA. Electronic address: [email protected].

PMID: 39488482
DOI: 10.1016/j.carrev.2024.10.007

Abstract

Background: The J-CTO investigators recently developed angiographic difficulty scores for each of the three major coronary arteries in patients undergoing first-attempt chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in de novo occlusions.

Methods: We examined the performance of the individual J-CTO scores in a large multicenter registry.

Results: The CTO lesion location was as follows: right coronary artery (RCA) 3,805 (54%), left anterior descending artery (LAD) 2,303 (33%), and left circumflex (LCX) 935 (13%). Patients in the PROGRESS-CTO registry were younger, more likely to be female, and had higher J-CTO scores compared with the J-CTO registry. Increasing difficulty scores were associated with lower technical success in the PROGRESS-CTO registry (score 0: 94.4 % - score ≥3: 82.6% for the RCA difficulty score; score 0: 96.4% - score ≥3: 86.1 for the LAD difficulty score; and score 0: 95.4% - score ≥3: 81.2% for the LCX difficulty score). The C-statistic of the coronary artery specific J-CTO scores in the PROGRESS-CTO registry were: LAD 0.69 (95% confidence intervals [CI], 0.64-0.73), LCX 0.63 (95% CI, 0.57-0.69), and RCA 0.61 (95-% CI, 0.58-0.64) with good calibration (Hosmer-Lemeshow p-value >0.05 for all). The AUC of the classic J-CTO score for LAD lesions was similar with the LAD J-CTO score (p-for-difference = 0.26), but worse for LCX (p-for-difference = 0.04) and RCA lesions (p-for-difference = 0.04).

Conclusion: In the PROGRESS-CTO registry, the coronary artery specific J-CTO scores did not improve prediction of the technical success of CTO-PCI compared with the classic J-CTO score.

Keywords: CTO; J-CTO; PCI; Validation.