In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure.
Background-Chronic total occlusion (CTO) recanalization is a complex and technically challenging procedure. The J-CTO score has been proposed to stratify case complexity and procedural success rates. However, the score has never been tested outside the setting of the original study. Moreover, its predictive value when using a hybrid antegrade or retrograde approach is unknown. We investigated the performance of the J-CTO score for predicting procedure complexity and success in an independent contemporary cohort. Methods and Results-A total of 209 consecutive patients who underwent CTO recanalization by a high-volume operator were included. Clinical and angiographic data were prospectively collected. The J-CTO score was applied for each patient, and discrimination and calibration were evaluated in the whole cohort, and according to the approach (antegrade 47% and retrograde 53%). Clinical and angiographic differences were noted between the original and studied cohort. The mean J-CTO score was 2.18±1.26, and successful guidewire crossing within 30 minutes and final angiographic success were 44.5% and 90.4%, respectively. The J-CTO score demonstrated good discrimination (c statistic, >0.70) and calibration (Hosmer-Lemeshow P>0.1) in the whole cohort and for antegrade and retrograde approaches. However, the final success rate was not associated with the J-CTO score. Conclusions-In this independent cohort, the J-CTO score showed good discriminatory and calibration capacity for guidewire CTO crossing within 30 minutes but it does not for final success rate. The J-CTO score helps to predict complexity of CTO recanalization, and the simplicity of the score supports the widespread use as a clinical tool.
Methods
Study Population and CTO ProceduresBetween January 2010 and December 2012, a total of 245 consecutive CTO PCI were performed by a single operator (S.R.). Of these, 36 (14.7%) patients were performed outside our institution and were not available for angiographic analysis. Hence, the final study population consisted of 209 patients, all patients referred for CTO PCI, without angiographic exclusion criteria. Baseline, procedural and hospitalization data were prospectively collected and entered in a dedicated database. Our institutional review committee approved prospective data collection as part of the Recherche Évaluative en Cardiologie InTervenionnelle (RÉCIT) registry, and subjects provided signed informed consent. A CTO was defined as an obstruction of a coronary artery with anterograde thrombolysis in myocardial infarction flow grade 0 that was confirmed or presumed to be ≥3 months old. 11 The duration of the CTO was estimated by clinical information or the results of previous angiography. Successful angiographic recanalization was defined as a restoration of thrombolysis in myocardial infarction flow grade 3 and residual stenosis <30% in the occluded artery. Successful procedure was defined as successful angiographic recanalization and no in-hospital major adverse cardiovascular event including death, strok...
SummaryNasal challenges with pollen grains are as close as possible to natural pollen exposure, but they are not well documented in grass pollen allergy. Forty‐four grass pollen allergic patients and ten non‐allergic volunteers were tested by means of nasal challenge, quantitative skin‐prick tests with a standardized orchard grass pollen extract and serum‐specific IgE. Nasal challenges were performed with lactose and increasing concentrations of orchard grass pollen grains (15–3645 grains, three‐fold increase). The test was considered to be positive when a symptom score over 5 was obtained, since this score had been previously correlated with the release of PGD2 in nasal secretions. All control subjects and 3/44 patients had a negative challenge. The number of orchard pollen grains required to elicit a positive challenge was 332 ± 440 (range: 15–1215 grains) and the distribution was Gaussian. This number is higher than expected according to pollen calendars performed during the season, but owing to the priming effect of the nasal mucosa by allergens it is compatible to natural exposure. The correlation between nasal provocation tests and skin‐prick test end‐points was significant (P < 0.005, Spearman rank test). Conversely there was no correlation between nasal challenge or skin‐prick test end‐point and serum‐specific IgE.
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