Abstract 11348: Predicting Successful Guide Wire Crossing Through Chronic Total Occlusion of Native Coronary Lesions within 30 Minutes: the J-CTO Score as a Difficulty Grading and Time Assessment Tool
Background: Clinical demand for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) lesions is currently increasing. However, its actual usage of the procedure remains low, due primarily to uncertainty of procedural success and difficulty of suitable case selection for CTO-PCI.
Purpose: This study was designed to establish a model for grading of difficulty in interventional CTO treatment.
Methods: Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire (GW) crossing within 30 minutes was set as an endpoint, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a ratio of 2:1. The J-CTO score was determined by assigning one point for each independent predictor of this endpoint 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 (1), difficult (2), and very difficult (≥3).
Results: The set endpoint 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 GW crossing within 30 minutes (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-operating characteristic curves were comparable (derivation: 0.82 vs validation: 0.76).
Conclusions: This model predicted the probability of successful GW crossing within 30 minutes very well, and can be applied for difficulty grading.
- © 2010 by American Heart Association, Inc.