Georgios Christopoulos1, R Michael Wyman1, Khaldoon Alaswad1, Dimitri Karmpaliotis1, William Lombardi1, J Aaron Grantham1, Robert W Yeh1, Farouc A Jaffer1, Daisha J Cipher1, Bavana V Rangan1, Georgios E Christakopoulos1, Megan A Kypreos1, Nicholas Lembo1, David Kandzari1, Santiago Garcia1, Craig A Thompson1, Subhash Banerjee1, Emmanouil S Brilakis2. 1. From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.). 2. From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.). esbrilakis@gmail.com.
Abstract
BACKGROUND: The performance of the Japan-chronic total occlusion (J-CTO) score in predicting success and efficiency of CTO percutaneous coronary intervention has received limited study. METHODS AND RESULTS: We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2011 and 2014 at 6 experienced centers in the United States. Six hundred and fifty-seven lesions were classified as easy (J-CTO=0), intermediate (J-CTO=1), difficult (J-CTO=2), and very difficult (J-CTO≥3). The impact of the J-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression, respectively. The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves. Antegrade wiring techniques were used more frequently in easy lesions (97%) than very difficult lesions (58%), whereas the retrograde approach became more frequent with increased lesion difficulty (41% for very difficult lesions versus 13% for easy lesions). The logistic regression model for technical success demonstrated satisfactory calibration and discrimination (P for Hosmer-Lemeshow =0.743 and area under curve =0.705). The J-CTO score was associated with a 2-fold increase in the odds of technical failure (odds ratio 2.04, 95% confidence interval 1.52-2.80, P<0.001). Procedure time increased by ≈20 minutes for every 1-point increase of the J-CTO score (regression coefficient 22.33, 95% confidence interval 17.45-27.22, P<0.001). CONCLUSIONS: J-CTO score was strongly associated with final success and efficiency in this study, supporting its expanded use in CTO interventions. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
BACKGROUND: The performance of the Japan-chronic total occlusion (J-CTO) score in predicting success and efficiency of CTO percutaneous coronary intervention has received limited study. METHODS AND RESULTS: We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2011 and 2014 at 6 experienced centers in the United States. Six hundred and fifty-seven lesions were classified as easy (J-CTO=0), intermediate (J-CTO=1), difficult (J-CTO=2), and very difficult (J-CTO≥3). The impact of the J-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression, respectively. The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves. Antegrade wiring techniques were used more frequently in easy lesions (97%) than very difficult lesions (58%), whereas the retrograde approach became more frequent with increased lesion difficulty (41% for very difficult lesions versus 13% for easy lesions). The logistic regression model for technical success demonstrated satisfactory calibration and discrimination (P for Hosmer-Lemeshow =0.743 and area under curve =0.705). The J-CTO score was associated with a 2-fold increase in the odds of technical failure (odds ratio 2.04, 95% confidence interval 1.52-2.80, P<0.001). Procedure time increased by ≈20 minutes for every 1-point increase of the J-CTO score (regression coefficient 22.33, 95% confidence interval 17.45-27.22, P<0.001). CONCLUSIONS: J-CTO score was strongly associated with final success and efficiency in this study, supporting its expanded use in CTO interventions. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
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