Zsolt Szijgyarto1, Rajiv Rampat2, Gerald S Werner3, Claudius Ho2, Nicolaus Reifart4, Thierry Lefevre5, Yves Louvard5, Alexandre Avran6, Mashayekhi Kambis7, Heinz-Joachim Buettner7, Carlo Di Mario8, Anthony Gershlick9, Javier Escaned10, George Sianos11, Alfredo Galassi12, Roberto Garbo13, Omer Goktekin14, Marcus Meyer-Gessner15, Bernward Lauer16, Simon Elhadad17, Alexander Bufe18, Nicolas Boudou19, Horst Sievert20, Victoria Martin-Yuste21, Leif Thuesen22, Andrejs Erglis23, Evald Christiansen24, James Spratt25, Lesciak Bryniarski26, Tim Clayton1, David Hildick-Smith27. 1. London School of Hygiene and Tropical Medicine, London, United Kingdom. 2. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. 3. Department of Cardiology & Intensive Care, Klinikum Darmstadt, Darmstadt, Germany. 4. Department of Cardiology, Main Taunus Heart Institute, Frankfurt am Main, Germany. 5. Department of Cardiology, Institut Cardiovasculaire Paris Sud, Paris, France. 6. Department of Cardiology, Arnault Tzanck Institut, Saint Laurent du Var, France. 7. Division of Cardiology and Angiology II, University Heart Center Freiburg, Freiburg, Germany. 8. Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. 9. Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom. 10. Hospital Clinico San Carlos IDISSC and Complutense, Madrid, Spain. 11. 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece. 12. Department of Experimental and Clinical Medicine, University of Catania, Catania, Italy. 13. Interventional Cardiology Unit, San Giovanni Bosco Hospital, Torino, Italy. 14. Department of Cardiology, Istanbul Memorial Hospital, Istanbul, Turkey. 15. Department of Cardiology, Augusta Krankenhaus, Düsseldorf, Germany. 16. Department of Cardiology, Kardiologie Zentralklinik, Bad Berka, Germany. 17. Department of Cardiology, Centre Hospitalier de Marne-la-vallée, Jossigny, France. 18. Helios Heart Center Krefeld, University Witten/Herdecke, Witten, Germany. 19. Cardiology Department, Rangueil University Hospital, Toulouse, France. 20. Department of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany. 21. Department of Cardiology, Hospital Clínic Barcelona, Barcelona, Spain. 22. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 23. Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia. 24. Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark. 25. Department of Cardiology, St. George's University NHS Trust, London, United Kingdom. 26. Department of Cardiology, Interventional Electrocardiology and Hypertension Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland. 27. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. Electronic address: david.hildick-smith@bsuh.nhs.uk.
Abstract
OBJECTIVES: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. BACKGROUND: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. METHODS: The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. RESULTS: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. CONCLUSIONS: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.
OBJECTIVES: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. BACKGROUND: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. METHODS: The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. RESULTS: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. CONCLUSIONS: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.
Authors: Dagmar F Hernandez-Suarez; Lorenzo Azzalini; Francesco Moroni; João Eduardo Tinoco de Paula; Pablo Lamelas; Carlos M Campos; Marcelo Harada Ribeiro; Evandro Martins Filho; Felix Damas de Los Santos; Lucio Padilla; Marco Alcantara-Melendez; Marcelo A Abud; Israel A Almodóvar-Rivera; Marcia Moura Schmidt; Mauro Echavarria; Antonio Carlos Botelho; Valentin Del Rio; Alexandre Quadros; Ricardo Santiago Journal: Catheter Cardiovasc Interv Date: 2021-12-20 Impact factor: 2.692
Authors: Pablo Salinas; Nieves Gonzalo; Víctor H Moreno; Manuel Fuentes; Sandra Santos-Martinez; José Antonio Fernandez-Diaz; Ignacio J Amat-Santos; Francisco Bosa Ojeda; Juan Caballero Borrego; Javier Cuesta; José María de la Torre Hernández; Alejandro Diego-Nieto; Daniela Dubois; Guillermo Galeote; Javier Goicolea; Alejandro Gutiérrez; Miriam Jiménez-Fernández; Jesús Jiménez-Mazuecos; Alfonso Jurado; Javier Lacunza; Dae-Hyun Lee; María López; Fernando Lozano; Javier Martin-Moreiras; Victoria Martin-Yuste; Raúl Millán; Gema Miñana; Mohsen Mohandes; Francisco J Morales-Ponce; Julio Núñez; Soledad Ojeda; Manuel Pan; Fernando Rivero; Javier Robles; Sergio Rodríguez-Leiras; Sergio Rojas; Juan Rondán; Eva Rumiz; Manel Sabaté; Juan Sanchís; Beatriz Vaquerizo; Javier Escaned Journal: PLoS One Date: 2021-04-02 Impact factor: 3.240
Authors: Leszek Bryniarski; Maksymilian P Opolski; Jarosław Wójcik; Maciej Lesiak; Tomasz Pawłowski; Jakub Drozd; Wojciech Wojakowski; Sławomir Surowiec; Maciej Dąbrowski; Adam Witkowski; Dariusz Dudek; Marek Grygier; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426