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

Georgios Christopoulos, MD,* David E. Kandzari, MD, Robert W. Yeh, MD, MBA, Farouc A. Jaffer, MD, PHD, Dimitri Karmpaliotis, MD, Michael R. Wyman, MD, Khaldoon Alaswad, MD, William Lombardi, MD, J. Aaron Grantham, MD,** Jeffrey Moses, MD, Georgios Christakopoulos, MD,* Muhammad Nauman J. Tarar, MD,* Bavana V. Rangan, BDS, MPH,* Nicholas Lembo, MD,y Santiago Garcia, MD,yy Daisha Cipher, PHD, Craig A. Thompson, MD, MMSC, Subhash Banerjee, MD,* Emmanouil S. Brilakis, MD, PHD*

OBJECTIVES: This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach.

BACKGROUND: Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning.

METHODS: We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort.

RESULTS: Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] . 0.88), moderate/severe tortuosity (b . 1.18), circumflex artery CTO (b . 0.99), and absence of “interventional” collaterals (b . 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square . 2.633; p . 0.268, and receiver-operator characteristic [ROC] area . 0.778) and validation (Hosmer-Lemeshow chi-square . 5.333; p . 0.070, and ROC area . 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference . 0.026, 95% confidence interval.0.093 to 0.144).

CONCLUSIONS: The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach. (J Am Coll Cardiol Intv 2016;9:1–9) © 2016 by the American College of Cardiology Foundation.

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