OBJECTIVES: This study sought to develop a scoring model predicting percutaneous coronary intervention (PCI) success in chronic total occlusions. BACKGROUND: Coronary chronic total occlusion is the lesion subtype in which angioplasty is most likely to fail. Chronic total occlusion for PCI (CTO-PCI) failure is associated with higher 1-year mortality and major adverse cardiac events compared with successful CTO-PCI. Although several independent predictors of final procedural success have been identified, no study has yet produced a model predicting final procedural outcome. METHODS: Data from 1,657 consecutive patients who underwent a first-attempt CTO-PCI were prospectively collected. The scoring model was developed in a derivation cohort of 1,143 patients (70%) using a multivariable stepwise analysis to identify independent predictors of CTO-PCI failure. The model was then validated in the remaining 514 (30%). RESULTS: The overall procedural success rate was 72.5%. Independent predictors of CTO-PCI failure were identified and included in the clinical and lesion-related score (CL-score) as follows: previous coronary artery bypass graft surgery +1.5 (odds ratio [OR]: 2.49, 95% confidence interval [CI]: 1.56 to 3.96), previous myocardial infarction +1 (OR: 1.6, 95% CI: 1.17 to 2.2), severe lesion calcification +2 (OR: 2.72, 95% CI :1.78 to 4.16), longer CTOs +1.5 (≥20 mm OR: 2.04, 95% CI: 1.54 to 2.7), non-left anterior descending coronary artery location +1 (OR: 1.56, 95% CI: 1.14 to 2.15), and blunt stump morphology +1 (OR: 1.39, 95% CI: 1.05 to 1.81). Score values of 0 to 1, >1 and <3, ≥3 and <5, and ≥5 identified subgroups at high, intermediate, low, and very low probability, respectively, of CTO-PCI success (derivation cohort: 84.9%, 74.9%, 58%, and 31.9%; p < 0,0001; validation cohort: 88.3%, 73.1%, 59.4%, and 46.2%; p < 0.0001). CONCLUSIONS: This clinical and angiographic score predicted the final CTO-PCI procedural outcome of our study population.
OBJECTIVES: This study sought to develop a scoring model predicting percutaneous coronary intervention (PCI) success in chronic total occlusions. BACKGROUND: Coronary chronic total occlusion is the lesion subtype in which angioplasty is most likely to fail. Chronic total occlusion for PCI (CTO-PCI) failure is associated with higher 1-year mortality and major adverse cardiac events compared with successful CTO-PCI. Although several independent predictors of final procedural success have been identified, no study has yet produced a model predicting final procedural outcome. METHODS: Data from 1,657 consecutive patients who underwent a first-attempt CTO-PCI were prospectively collected. The scoring model was developed in a derivation cohort of 1,143 patients (70%) using a multivariable stepwise analysis to identify independent predictors of CTO-PCI failure. The model was then validated in the remaining 514 (30%). RESULTS: The overall procedural success rate was 72.5%. Independent predictors of CTO-PCI failure were identified and included in the clinical and lesion-related score (CL-score) as follows: previous coronary artery bypass graft surgery +1.5 (odds ratio [OR]: 2.49, 95% confidence interval [CI]: 1.56 to 3.96), previous myocardial infarction +1 (OR: 1.6, 95% CI: 1.17 to 2.2), severe lesion calcification +2 (OR: 2.72, 95% CI :1.78 to 4.16), longer CTOs +1.5 (≥20 mm OR: 2.04, 95% CI: 1.54 to 2.7), non-left anterior descending coronary artery location +1 (OR: 1.56, 95% CI: 1.14 to 2.15), and blunt stump morphology +1 (OR: 1.39, 95% CI: 1.05 to 1.81). Score values of 0 to 1, >1 and <3, ≥3 and <5, and ≥5 identified subgroups at high, intermediate, low, and very low probability, respectively, of CTO-PCI success (derivation cohort: 84.9%, 74.9%, 58%, and 31.9%; p < 0,0001; validation cohort: 88.3%, 73.1%, 59.4%, and 46.2%; p < 0.0001). CONCLUSIONS: This clinical and angiographic score predicted the final CTO-PCI procedural outcome of our study population.
Authors: Neel M Butala; Hector Tamez; Eric A Secemsky; J Aaron Grantham; John A Spertus; David J Cohen; Philip Jones; Adam C Salisbury; Suzanne V Arnold; Frank Harrell; William Lombardi; Dimitrios Karmpaliotis; Jeffrey Moses; James Sapontis; Robert W Yeh Journal: J Am Heart Assoc Date: 2022-05-16 Impact factor: 6.106
Authors: Mohammad Hasan Namazi; Ali Reza Serati; Hosein Vakili; Morteza Safi; Saeed Ali Pour Parsa; Habibollah Saadat; Maryam Taherkhani; Sepideh Emami; Shamseddin Pedari; Masoomeh Vatanparast; Mohammad Reza Movahed Journal: Int J Angiol Date: 2016-10-31
Authors: Barbara Anna Danek; Aris Karatasakis; Dimitri Karmpaliotis; Khaldoon Alaswad; Robert W Yeh; Farouc A Jaffer; Mitul P Patel; Ehtisham Mahmud; William L Lombardi; Michael R Wyman; J Aaron Grantham; Anthony Doing; David E Kandzari; Nicholas J Lembo; Santiago Garcia; Catalin Toma; Jeffrey W Moses; Ajay J Kirtane; Manish A Parikh; Ziad A Ali; Judit Karacsonyi; Bavana V Rangan; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis Journal: J Am Heart Assoc Date: 2016-10-11 Impact factor: 5.501
Authors: Luiz Fernando Ybarra; Marcelo J C Cantarelli; Viviana M G Lemke; Alexandre Schaan de Quadros Journal: Arq Bras Cardiol Date: 2018-05 Impact factor: 2.000