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Novel scoring system valid tool for predicting CTO PCI success
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The PROGRESS CTO score appears to be an effective method for predicting the technical success probability of PCI for chronic total occlusion and guiding clinical decisions, according to recent findings.
Georgios Christopoulos, MD, from the VA North Texas Health Care System and University of Texas Southwestern Medical Center in Dallas, and colleagues assessed clinical and angiographic information on 781 consecutive patients at seven U.S. centers included in the PROGRESS CTO study between 2012 and January 2015.
The researchers performed analyses in population subsets for derivation (two-thirds random sampling rate, 521 lesions) and validation (one-third random sampling rate, 260 lesions). They performed univariable analysis to determine clinical and angiographic variables correlated with technical failure; variables with a strong association were entered into a multivariable model. These variables were assigned 1 point, and the sum of all points was used to develop a 4-point score. An analysis of the validation cohort compared the PROGRESS CTO score with the J-CTO score. The derivation subset consisted of 521 CTO PCIs, 482 of which achieved technical success (92.5%).
Compared with successful procedures, failed procedures were more likely to be performed in patients with previous PCI (84% vs. 66%; P < .023), proximal cap ambiguity (52% vs. 26%; P = .006), lack of interventional collaterals (58% vs. 35%; P = .034), moderate/severe tortuosity (56% vs. 31%; P = .005) and left circumflex artery as the target vessel (39% vs. 17%; P < .001).
The score yielded based on these variables showed good calibration and discrimination in the derivation subset (Hosmer-Lemeshow chi-square = 2.633; P = .268; receiver-operator characteristic [ROC] area = 0.778) and the validation (Hosmer-Lemeshow chi-square = 5.333; P = .07; ROC area = 0.72) subset. Analysis in the validation cohort found that the PROGRESS CTO and J-CTO scores had similar performance in predicting technical success (ROC area, 0.72 vs. 0.746; area under the curve difference = 0.026; 95% CI, –0.093 to 0.144).
“Evaluation of four baseline angiographic characteristics (proximal cap ambiguity, absence of retrograde collaterals, moderate or severe tortuosity, and [left circumflex] CTO) can be used to determine the likelihood of technical success with CTO PCI,” the researchers wrote. “The PROGRESS CTO score is a simple tool that can be used in clinical practice to predict CTO PCI success and guide clinical decision making.” – by Jennifer Byrne
Disclosure: Christopoulos reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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