Procedural Outcomes of Revascularization of Chronic Total Occlusion of Native Coronary Arteries (from a Multicenter United States Registry)

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...

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“…23,24 J-CTO score could help the physician to predict complexity, which is usually related with higher complications rates.…”

Section: Discussionmentioning

confidence: 99%

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Nombela‐Franco

Ureña

Jerez-Valero

et al. 2013

Circ: Cardiovascular Interventions

101

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“…In 2005 only 10-15% of patients with CTO qualified for PCI as most CTO patients underwent cardiac surgery or conservative treatment [3]. Due to the development of advanced and dedicated devices as well as new techniques and, in particular, the growing experience of operators, the number of CTO recanalization procedures significantly increased and the effectiveness of PCI CTO reached approximately 80-90% [4][5][6]. Long-term results of successful recanalization of CTO are contradictory [7][8][9][10], but a meta-analysis published in 2012 underlines the improvement at 5 years after effective CTO recanalization by showing a significant reduction of mortality [11].…”

Section: Discussionmentioning

confidence: 99%

Chronic Total Occlusion of the Left Main Coronary Artery in a 63-Year- Old Woman after Triple Coronary Bypass Surgery

Zajdel¹,

Andres²,

Durak³

2016

J Clin Exp Cardiolog

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“…PCI procedures of CTO following long-term CABG are associated with a significantly higher rate of unsuccessful revascularization (21,22). It is reported that approximately half of the patients with prior CABG have native coronary CTO (23).…”

Section: Cto With Coronary Artery Bypass Graft (Cabg)mentioning

confidence: 99%

Pathology of Coronary Chronic Total Occlusion

Sakakura

Yahagi

Virmani

2016

Int Cardiovasc Res J

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There is an increasing need for percutaneous revascularization procedures of coronary Chronic Total Occlusion (CTO), because many patients with severe coronary artery disease have limited options for revascularization. Although the success rate of percutaneous revascularization of CTOs was unsatisfactory from the 1990s to the 2000s, recent technological advances in interventional strategies have improved the success rate to 85%. Detailed histological assessment of human autopsy studies of CTO has contributed significantly to the refinement in Percutaneous Coronary Intervention (PCI) techniques and device development. We have recently reported the pathological findings and characteristics of CTOs that occur in different clinical scenarios. In this review, we discuss the pathology of CTOs to facilitate greater understanding of revascularization strategies for CTOs.

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Procedural Outcomes of Revascularization of Chronic Total Occlusion of Native Coronary Arteries (from a Multicenter United States Registry)

Cited by 106 publications

References 18 publications

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Chronic Total Occlusion of the Left Main Coronary Artery in a 63-Year- Old Woman after Triple Coronary Bypass Surgery

Pathology of Coronary Chronic Total Occlusion

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