Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention
Cheol-Woong Yu, MD, PhD*; Hyun-Jong Lee, MD, PhD*; Jon Suh, MD, PhD; Nae-Hee Lee, MD, PhD; Sang-Min Park, MD; Taek Kyu Park, MD; Jeong Hoon Yang, MD; Young Bin Song, MD, PhD; Joo-Yong Hahn, MD, PhD; Seung Hyuk Choi, MD, PhD; Hyeon-Cheol Gwon, MD, PhD; Sang-Hoon Lee, MD, PhD; Yeon Hyeon Choe, MD, PhD; Sung Mok Kim, MD, PhD; Jin-Ho Choi, MD, PhD*
Background: We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography.
Methods and results: A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length ≥15 mm, severe calcification, whole luminal calcification, reattempt, and ≥12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing ≤30 minutes declined consistently from 100% to 0% according to the KCCT score (P<0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics=0.78 versus 0.65-0.72, P<0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of <4 for guidewire crossing ≤30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (P<0.05, all). These results could be reproduced in validation data set (P<0.05, all).
Conclusions: KCCT scoring could predict successful guidewire crossing ≤30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention.
Keywords: angiography; computed tomographic angiography; percutaneous coronary intervention; probability; sensitivity and specificity.
© 2017 American Heart Association, Inc.
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