Abstract 16117: Clinical and Angiographic Scoring System to Predict the Probability of Successful First Attempt PCI in Patients With Coronary Chronic Total Occlusion
Background: Coronary chronic total occlusion (CTO) remains the lesion subtype in which angioplasty has the lowest success rate. Although many independent predictors of final procedural success have been identified, no studies have yet analyzed their combined impact on final procedural outcome. In order to obtain a scoring model to predict final CTO-PCI success, we analyzed a population of patients who underwent a percutaneous coronary intervention for a chronic total occlusion (CTO-PCI) at our institution.
Methods: We included 1,657 consecutive patients who underwent a first-attempt CTO-PCI at ICPS from January 2004 to December 2013. Clinical, angiographic procedural and technical characteristics were prospectively collected. A backword stepwise logistic regression including clinical and angiographic variables was used to create a multivariable model of independent predictors of CTO-PCI success. Independent variables were then scored.
Results: Overall procedural success rate was 72.5%. The backward logistic regression model showed that two clinical variables: previous CABG (OR2.28, 95%CI1.53-3.4), previous MI (1.56, 95%CI 1.19-2.0) and four angiographic variables: severe lesion calcification (OR 2.95, 95%CI 2.08-4.2), longer CTOs (≥20 mm: OR 2.04, 95%CI 1.62-2.58), non LAD location (OR 1.58, 95%CI 1.21-2-06) and blunt stump morphology (OR 1.57, 95%CI 1.24-1.99) were independent predictors of CTO-PCI failure. The OR values of these variables were used to create the Clinical and Angiographic Scoring System (CL-SCORE). CL-Score values of 0, 1-3, >3 and ≤5 and >5 indentified subgroups at high (class 0), intermediate (class 1), low (class 2), very low (class 3) probability of CTO-PCI success (80.3%, 64.2%, 49.4 and 29% respectively; p<0,0001) Figure 1. The probability of CTO-PCI failure increased significantly from class 0 to class 1 (19.7% to 35.8%, p<0.0001), from class 1 to class 2 (35.8 to 50.6 p<0.0001) and from class 2 to class 3 (50.6% to 81% p=0.001), respectively.
Conclusion: This clinical and angiographic score strongly predicted the final CTO-PCI procedural outcome of our study population. Further studies are required to validate this model.
Author Disclosures: G. Alessandrino: None. Y. Louvard: None. T. Lefevre: None. P. Garot: None. F. Sanguineti: None. T. Unterseeh: None. T. Hovasse: None. B. Chevalier: None. M. Morice: None.
- © 2014 by American Heart Association, Inc.