open access

Ahead of print
Original Article
Published online: 2021-06-09
Get Citation

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

Mohsen Mohandes, Cristina Moreno, Sergio Rojas, Victor Doblas, Mónica Fuertes, Francisco Fernández, Alberto Pernigotti, Jordi Guarinos, Mercé Camprubi, Alfredo Bardají
DOI: 10.5603/CJ.a2021.0058
·
Pubmed: 34125431

open access

Ahead of print
Original articles
Published online: 2021-06-09

Abstract

Background: Several scoring systems have been described to assess the level of difficulty and to predict the probability of success of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). The J-CTO score was initially developed to correlate CTO complexity with guidewire time crossing through the lesion within 30 min. Moreover, almost all scoring systems represent procedures performed by seasoned operators. Herein, this study sought to evaluate the predictive capacity of J-CTO for PCI success in a European single-center cohort with growing experience in the approach of CTO.

Methods: 526 procedures were performed between 2007 and 2020 mainly by a single operator. The predictive power of J-CTO score was assessed by area under the receiver-operator characteristic curve (ROC) in the entire cohort and additionally in two separate periods. The goodness-of-fit of the model was evaluated by the Hosmer and Lemeshow statistic.

Results: Successful procedure in first-attempt PCI was 79.5% and the overall success including 47 repeated procedures was achieved in 85.8%. The retrograde approach was attempted in 14.4%. The score was inversely associated with procedural success and lower success rate in more difficult CTOs (p < 0.001). ROC curve for the entire cohort, and first block (case 1–200) and second block (case 201–526) was 0.696, 0.661 and 0.748, respectively. The model showed good calibration for the entire cohort (X2 = 1.7; p = 0.43).

Conclusions: J-CTO score showed an acceptable predictive power for procedural success in this cohort although its discriminatory power is better as the level of experience is improved.

Abstract

Background: Several scoring systems have been described to assess the level of difficulty and to predict the probability of success of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). The J-CTO score was initially developed to correlate CTO complexity with guidewire time crossing through the lesion within 30 min. Moreover, almost all scoring systems represent procedures performed by seasoned operators. Herein, this study sought to evaluate the predictive capacity of J-CTO for PCI success in a European single-center cohort with growing experience in the approach of CTO.

Methods: 526 procedures were performed between 2007 and 2020 mainly by a single operator. The predictive power of J-CTO score was assessed by area under the receiver-operator characteristic curve (ROC) in the entire cohort and additionally in two separate periods. The goodness-of-fit of the model was evaluated by the Hosmer and Lemeshow statistic.

Results: Successful procedure in first-attempt PCI was 79.5% and the overall success including 47 repeated procedures was achieved in 85.8%. The retrograde approach was attempted in 14.4%. The score was inversely associated with procedural success and lower success rate in more difficult CTOs (p < 0.001). ROC curve for the entire cohort, and first block (case 1–200) and second block (case 201–526) was 0.696, 0.661 and 0.748, respectively. The model showed good calibration for the entire cohort (X2 = 1.7; p = 0.43).

Conclusions: J-CTO score showed an acceptable predictive power for procedural success in this cohort although its discriminatory power is better as the level of experience is improved.

Get Citation

Keywords

percutaneous coronary intervention, chronic total occlusion (CTO), J-CTO score

About this article
Title

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-06-09

DOI

10.5603/CJ.a2021.0058

Pubmed

34125431

Keywords

percutaneous coronary intervention
chronic total occlusion (CTO)
J-CTO score

Authors

Mohsen Mohandes
Cristina Moreno
Sergio Rojas
Victor Doblas
Mónica Fuertes
Francisco Fernández
Alberto Pernigotti
Jordi Guarinos
Mercé Camprubi
Alfredo Bardají

References (23)
  1. Yamane M. Current percutaneous recanalization of coronary chronic total occlusion. Revista Española de Cardiología (English Edition). 2012; 65(3): 265–277.
  2. Azzalini L, Carlino M, Bellini B, et al. Long-Term Outcomes of Chronic Total Occlusion Recanalization Versus Percutaneous Coronary Intervention for Complex Non-Occlusive Coronary Artery Disease. Am J Cardiol. 2020; 125(2): 182–188.
  3. Werner GS, Martin-Yuste V, Hildick-Smith D, et al. EUROCTO trial investigators. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J. 2018; 39(26): 2484–2493.
  4. Christopoulos G, Kandzari DE, Yeh RW, et al. Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv. 2016; 9(1): 1–9.
  5. Alessandrino G, Chevalier B, Lefèvre T, et al. A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC Cardiovasc Interv. 2015; 8(12): 1540–1548.
  6. De Jin C, Kim MH, Kim SJ, et al. Predicting successful recanalization in patients with native coronary chronic total occlusion: the Busan CTO Score. Cardiology. 2017; 137(2): 83–91.
  7. Morino Y, Abe M, Morimoto T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes. JACC: Cardiovasc Interv. 2011; 4(2): 213–221.
  8. Nombela-Franco L, Urena M, Jerez-Valero M, et al. Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort. Circ Cardiovasc Interv. 2013; 6(6): 635–643.
  9. Young MN, Secemsky EA, Kaltenbach LA, et al. Examining the operator learning curve for percutaneous coronary intervention of chronic total occlusions. Circ Cardiovasc Interv. 2019; 12(8): e007877.
  10. Galassi AR, Werner GS, Boukhris M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019; 15(2): 198–208.
  11. Mohandes M, Guarinos J, Rodríguez J, et al. Marcadores angiográficos negativos en la intervención coronaria percutánea de las oclusiones totales crónicas. Archivos de Cardiología de México. 2018; 88(2): 93–99.
  12. Morino Y, Kimura T, Hayashi Y, et al. In-Hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion. JACC: Cardiovasc Interv. 2010; 3(2): 143–151.
  13. Thygesen K, Alpert J, Jaffe A, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2018; 40(3): 237–269.
  14. Sathananthan J, Džavík V. Coronary intervention for chronic total occlusion: current indications and future directions. Coron Artery Dis. 2017; 28(5): 426–436.
  15. Hirai K, Sakakura K, Watanabe Y, et al. Determinants of high device cost in current percutaneous coronary interventions. Cardiovasc Revasc Med. 2018; 19(5 Pt B): 607–612.
  16. Brilakis ES, Banerjee S, Karmpaliotis D, et al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 2015; 8(2): 245–253.
  17. Brilakis ES, Grantham JA, Rinfret S, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012; 5(4): 367–379.
  18. Karatasakis A, Danek BA, Karmpaliotis D, et al. Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention. Int J Cardiol. 2016; 224: 50–56.
  19. Szijgyarto Z, Rampat R, Werner GS, et al. Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score. JACC Cardiovasc Interv. 2019; 12(4): 335–342.
  20. Galassi AR, Boukhris M, Azzarelli S, et al. Percutaneous coronary revascularization for chronic total occlusions: a novel predictive score of technical failure using advanced technologies. JACC Cardiovasc Interv. 2016; 9(9): 911–922.
  21. Karatasakis A, Danek BA, Brilakis ES. Scoring systems for chronic total occlusion percutaneous coronary intervention: if you fail to prepare you are preparing to fail. J Thorac Dis. 2016; 8(9): E1096–E1099.
  22. Karacsonyi J, Stanberry L, Alaswad K, et al. Predicting technical success of chronic total occlusion percutaneous coronary intervention: comparison of 3 scores. Circ Cardiovasc Interv. 2021; 14(1): e009860.
  23. Christopoulos G, Wyman RM, Alaswad K, et al. Clinical utility of the Japan-chronic total occlusion score in coronary chronic total occlusion interventions: results from a multicenter registry. Circ Cardiovasc Interv. 2015; 8(7): e002171.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl