Comparison among Different Scoring Systems in Predicting Procedural Success and Long-Term Outcomes after Percutaneous Coronary Intervention in Patients with Chronic Total Coronary Artery Occlusions

Abstract

Background and objectives: Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure. Materials and Methods: A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan–Meier method and Cox regression were used to estimate the association with death from any cause after a successful procedure, Results: 454 of 551cases were successful. With increasing disease complexity, the procedural success rate was significantly reduced in all scoring systems (p < 0.001): Area under the curve was 0.714 for J CTO score, 0.605 for PROGRESS CTO, 0.624 for CL and 0.641 for CASTLE scores. During the median 6.8 years of follow-up time, survival was better in the successful procedure group (p = 0.041). Among patients with procedural success, only PROGRESS and CASTLE scores showed an association with all-cause risk of death. After adjustment for baseline characteristics, patients having high PROGRESS score had almost twice higher risk of death (HR 1.81(95% CI 1.19–2.75)), and those with high and intermediate CASTLE score experienced almost four (HR 3.68(95% CI 1.50–9.05)) and two (HR 2.15, (95% CI 1.42–3.23)) times higher risk of death than the low score patients, respectively. Conclusions: All four CTO scoring systems had moderate ability to predict procedural success. More complex CTO PCI patients, assessed by PROGRESS and CASTLE scores, has worse all-cause survival in six to seven years after a successful procedure; whereas J CTO and CL scores had no association with survival.

A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention

“…Establishing scoring systems could effectively predict the success of CTO recanalization, accurately select appropriate patients for attempting PCI, and ultimately achieve a satisfactory immediate and long-term prognosis. However, these scoring systems exhibited moderate-level performance in predicting the technical outcome of CTO PCI ( 15 ) and experienced in our center.…”

Procedural Success Prediction Scoring Systems Used in Percutaneous Coronary Interventions for Chronic Total Occlusions: A Systematic Evaluation

“…All included studies had an observational design with the scores being applied retrospectively. The most investigated score in clinical studies was J-CTO [15,17,[20][21][22][23][24][25][26][27][28][29][30]34,37,38,[40][41][42][43][44][45][46] followed by PROGRESS-CTO score [18,22,24,28,37,38,41,44,46]. PCI success rate varied across studies from 48.2% [30] to 94.4% [21].…”

“…Nonetheless, a small cohort of patients was included, and results should be confirmed in more extensive studies. CASTLE (EuroCTO) score was derived and externally validated in large cohorts of patients [22,23,37,39]. Though the CASTLE score had a modest predictive value, with AUC ranging from 0.633-0.68, it was comparable to the J-CTO score.…”

“…The CASTLE score had lower performance in complex lesions, but it was still better than the J-CTO score (AUC 0.588 vs. 0.473). [23] Since its development, the CL score has been extensively validated in different studies [15,22,24,37,38,44]. The predictive value of the CL score varies across studies with AUC ranging from 0.624 [22] to 0.800 [38], which is slightly better than the J-CTO score in some cases [15,24,37].…”

“…[23] Since its development, the CL score has been extensively validated in different studies [15,22,24,37,38,44]. The predictive value of the CL score varies across studies with AUC ranging from 0.624 [22] to 0.800 [38], which is slightly better than the J-CTO score in some cases [15,24,37]. Some studies developed original scores for successful PCI prediction [16,19,25,[31][32][33]35].…”