Predicting Successful Guidewire Crossing Through Chronic Total Occlusion of Native Coronary Lesions Within 30 Minutes

The J-CTO (Multicenter CTO Registry in Japan) Score as a Difficulty Grading and Time Assessment Tool.

Yoshihiro Morino, MD,* Mitsuru Abe, MD, Takeshi Morimoto, MD,§ Takeshi Kimura, MD, Yasuhiko Hayashi, MD, Toshiya Muramatsu, MD, Masahiko Ochiai, MD, Yuichi Noguchi, MD,** Kenichi Kato, MD, Yoshisato Shibata, MD, Yoshikazu Hiasa, MD, Osamu Doi, MD, Takehiro Yamashita, MD, Tomoaki Hinohara, MD, Hiroyuki Tanaka, MD,*** Kazuaki Mitsudo, MD,*** for the J-CTO Registry Investigators

Objectives: This study sought to establish a model for grading lesion difficulty in interventional chronic total occlusion (CTO) treatment.

Background: Owing to uncertainty of success of the procedure and difficulties in selecting suitable cases for treatment, performance of interventional CTO remains infrequent.

Methods: Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire crossing within 30 min was set as an end point, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a 2:1 ratio. The J-CTO (Multicenter CTO Registry of Japan) score was determined by assigning 1 point for each independent predictor of this end point and summing all points accrued. This value was then used to develop a model stratifying all lesions into 4 difficulty groups: easy (J-CTO score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of ≥ 3).

Results: The set end point was achieved in 48.2% of lesions. Independent predictors included calcification, bending, blunt stump, occlusion length >20 mm, and previously failed lesion. Easy, intermediate, difficult, and very difficult groups, stratified by J-CTO score, demonstrated stepwise, proportioned, and highly reproducible differences in probability of successful guidewire crossing within 30 min (87.7%, 67.1%, 42.4%, and 10.0% in the derivation set and 92.3%, 58.3%, 34.8%, and 22.2% in the validation set, respectively). Areas under receiver-operator characteristic curves were comparable (derivation: 0.82 vs. validation: 0.76).

Conclusions: This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading.

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