Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score.

Aged Aged, 80 and over Chronic Disease Coronary Occlusion / diagnostic imaging Databases, Factual Decision Support Techniques Europe Female Humans Male Middle Aged Percutaneous Coronary Intervention / adverse effects Predictive Value of Tests Registries Reproducibility of Results Risk Assessment Risk Factors Treatment Failure

chronic total occlusion coronary artery disease percutaneous coronary intervention scoring system

Journal

JACC. Cardiovascular interventions

ISSN: 1876-7605

Titre abrégé: JACC Cardiovasc Interv

Pays: United States

ID NLM: 101467004

Informations de publication

Date de publication:
25 02 2019

Historique:

received: 05 09 2018

revised: 09 10 2018

accepted: 13 11 2018

pubmed: 4 2 2019

medline: 26 3 2020

entrez: 4 2 2019

Statut: ppublish

Résumé

The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.

Sections du résumé

OBJECTIVES

The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty.

BACKGROUND

Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making.

METHODS

The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure.

RESULTS

There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets.

CONCLUSIONS

The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.

Identifiants

DOI: 10.1016/j.jcin.2018.11.020 PMID: 30711551

pubmed: 30711551

pii: S1936-8798(18)32310-0

doi: 10.1016/j.jcin.2018.11.020

pii:

doi:

Types de publication

Journal Article Multicenter Study Validation Study

Langues

eng

Sous-ensembles de citation

Pagination

335-342

Commentaires et corrections

Type : CommentIn