Objectives This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach. Background Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning. Methods We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort. Results Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144). Conclusions The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach.
Bibliographical noteFunding Information:
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr. Kandzari has received consulting honoraria from Boston Scientific and Medtronic Cardiovascular; and has received research/grant support from Abbott, Boston Scientific, and Medtronic Cardiovascular. Dr. Yeh has received a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute; has served as a consultant for Abbott Vascular, Gilead Sciences, and Boston Scientific; has served on the advisory board of Abbott Vascular; and receives salary support from Harvard Clinical Research Institute. Dr. Jaffer has served as a consultant to Boston Scientific, Siemens, and Merck; has received nonfinancial research support from Abbott Vascular; and has received research grants from the National Institutes of Health (HL-R01-108229), Siemens, and Kowa. Dr. Karmpaliotis has served on the Speakers Bureau for Abbott Vascular, Boston Scientific, and Medtronic; and has served as a consultant to Bridgepoint Medical. Dr. Wyman has received honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. Dr. Alaswad has received consulting fees from Terumo, Asahi Intecc, and Boston Scientific; and has served as a consultant without financial support from Abbott Laboratories. Dr. Lombardi has equity with Bridgepoint Medical; and has served as a consultant to Boston Scientific, Abiomed, and Abbott Vascular. Dr. Grantham has received speaking fees, consulting fees, and honoraria from Boston Scientific, Abbott Vascular, and Asahi Intecc; has received research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, and Medtronic; is a member of the Boston Scientific Executive Physician Leadership Committee; is on the advisory board for BSCI; and is on the CTO advisory board for Abbott Vascular. Dr. Moses has served as a consultant to Boston Scientific and Abbott Vascular. Dr. Rangan has received research grants from Infraredx and The Spectranetics Corporation. Dr. Lembo has served on the Speakers Bureau for Abbott Vascular, Boston Scientific, and Medtronic; and has served on the advisory board for Abbott Vascular and Medtronic. Dr. Garcia has received consulting fees from Medtronic and Surmodics. Dr. Thompson is an employee of Boston Scientific. Dr. Banerjee has received research grants from Gilead and the Medicines Company; has received consultant/speaker honoraria from Covidien, Medtronic, and Merck; has ownership in MDCARE Global and received an educational grant from Boston Scientific (both spouse); and has intellectual property in HygeiaTel. Dr. Brilakis has received consulting/speaker honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, and Terumo; has received research support from Boston Scientific and Infraredx; and his spouse is an employee of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at University of Texas Southwestern Medical Center (33). REDCap is a secure, web-based application designed to support data capture for research studies, providing: 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources.
- chronic total occlusion
- percutaneous coronary intervention
- technical success