Abstract 15442: Predictive Value of the J-CTO Score in Percutaneous Coronary Interventions for Chronic Total Occlusions
Introduction The J-CTO score has been shown to predict successful guidewire crossing within 30 minutes in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in a multicentre Japanese registry.
Hypothesis We assessed the hypothesis that the J-CTO score is a useful risk score for the prediction of procedural failure of PCI for CTO in a different cohort of patients.
Methods The study included all consecutive patients undergoing PCI for CTO at 3 tertiary PCI centres between January 2004 and December 2011. The J-CTO score assigns 1 point to each of the following: calcification, bending, blunt stump, occlusion length ≥20 mm, and previously failed lesion and classifies lesions as easy (score of 0), intermediate (score of 1), difficult (score of 2), and “very difficult” (score of ≥3). A multivariable mixed effect logistic regression for clustered data was used to assess the impact of J-CTO score on PCI failure. Model calibration was assessed as difference between predicted probabilities with the worst or best prognosis (PSEP). Areas under receiver-operating characteristic curve (AUC) were computed.
Results A total of 1261 patients, median age 63 yrs-old (25th-75th percentile, 55-72), undergoing PCI for 1418 CTO were included. PCI failure occurred in 410 (28.9%) lesions. Failure rate significantly increased with increasing J-CTO score (13.6%, 24.7%, 37.0%, 44.8%, in the groups with J-CTO score of 0, 1, 2, ≥3, respectively, p<0.001). At multivariable logistic regression J-CTO score was a significant predictor of failure (odds ratio 1.68, 95% confidence interval (CI) 1.43-1.97, p<0.001, for each unit increase in J-CTO score). PSEP was 0.34 and 0.33 in a model containing J-CTO score only, or containing J-CTO score in addition to clinical, procedural variables and vessel site, respectively. The AUC of a model containing J-CTO score only was significantly higher than AUC of a model containing J-CTO score in addition to clinical, procedural variables and vessel site (0.77, 95% CI 0.75-0.80, vs. 0.71, 95% CI 0.69- 0.74, p<0.001).
Conclusions The J-CTO score is an independent predictor of failure of PCI for CTO and has a good predictive accuracy as stand-alone risk score.
- © 2012 by American Heart Association, Inc.