Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

Pablo Salinas, Nieves Gonzalo, Víctor H Moreno, Manuel Fuentes, Sandra Santos-Martinez, José Antonio Fernandez-Diaz, Ignacio J Amat-Santos, Francisco Bosa Ojeda, Juan Caballero Borrego, Javier Cuesta, José María de la Torre Hernández, Alejandro Diego-Nieto, Daniela Dubois, Guillermo Galeote, Javier Goicolea, Alejandro Gutiérrez, Miriam Jiménez-Fernández, Jesús Jiménez-Mazuecos, Alfonso Jurado, Javier Lacunza, Dae-Hyun Lee, María López, Fernando Lozano, Javier Martin-Moreiras, Victoria Martin-Yuste, Raúl Millán, Gema Miñana, Mohsen Mohandes, Francisco J Morales-Ponce, Julio Núñez, Soledad Ojeda, Manuel Pan, Fernando Rivero, Javier Robles, Sergio Rodríguez-Leiras, Sergio Rojas, Juan Rondán, Eva Rumiz, Manel Sabaté, Juan Sanchís, Beatriz Vaquerizo, Javier Escaned, Pablo Salinas, Nieves Gonzalo, Víctor H Moreno, Manuel Fuentes, Sandra Santos-Martinez, José Antonio Fernandez-Diaz, Ignacio J Amat-Santos, Francisco Bosa Ojeda, Juan Caballero Borrego, Javier Cuesta, José María de la Torre Hernández, Alejandro Diego-Nieto, Daniela Dubois, Guillermo Galeote, Javier Goicolea, Alejandro Gutiérrez, Miriam Jiménez-Fernández, Jesús Jiménez-Mazuecos, Alfonso Jurado, Javier Lacunza, Dae-Hyun Lee, María López, Fernando Lozano, Javier Martin-Moreiras, Victoria Martin-Yuste, Raúl Millán, Gema Miñana, Mohsen Mohandes, Francisco J Morales-Ponce, Julio Núñez, Soledad Ojeda, Manuel Pan, Fernando Rivero, Javier Robles, Sergio Rodríguez-Leiras, Sergio Rojas, Juan Rondán, Eva Rumiz, Manel Sabaté, Juan Sanchís, Beatriz Vaquerizo, Javier Escaned

Abstract

Background: We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.

Methods: Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.

Results: Mean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, p<0.001), similar to J-CTO and slightly inferior to CL score (- 0.011, p = 0.004). Regarding net reclassification improvement, CASTLE reclassified better than PROGRESS (overall continuous net reclassification improvement 0.379, p<0.001) in roughly 20% of cases.

Conclusion: Procedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

Conflict of interest statement

Abbott provided an unrestricted grant to support the Registry and this publication’s fees. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Barchart of scoring distribution.
Fig 1. Barchart of scoring distribution.
The study population scoring distribution (n = 1342 CTOs) is shown in blue. Original derivation cohort scoring distribution is shown in gray, but for CL score (not available in original publication). Note that 0.5 and 7.5 are not possible to be obtained in CL-score.
Fig 2. Expected success rates versus observed…
Fig 2. Expected success rates versus observed success rates across different strata of each score.
P values for linear trend and Hosmer-Lemeshow (HL) tests are provided.
Fig 3. ROC curve and AUC of…
Fig 3. ROC curve and AUC of each score discriminating procedural success.
Comparison between AUCs were done taking CASTLE score as a reference.

References

    1. Picano Eugenio, Vano Eliseo. Radiation exposure as an occupational hazard. EuroIntervention. 26 de Octubre de 2012;8(6):649–53. 10.4244/EIJV8I6A101
    1. Galassi A, Werner G, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club [Internet]. EuroIntervention. [citado 10 de agosto de 2019]. Disponible en:
    1. Tajti P, Burke MN, Karmpaliotis D, Alaswad K, Werner GS, Azzalini L, et al.. Update in the Percutaneous Management of Coronary Chronic Total Occlusions. JACC Cardiovasc Interv. 9 de Abril de 2018;11(7):615–25. 10.1016/j.jcin.2017.10.052
    1. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al.. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 20 de Febrero de 2019;14(14):1435–534.
    1. Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, et al.. Predicting Successful Guidewire Crossing Through Chronic Total Occlusion of Native Coronary Lesions Within 30 Minutes: The J-CTO (Multicenter CTO Registry in Japan) Score as a Difficulty Grading and Time Assessment Tool. JACC Cardiovasc Interv. 1 de Febrero de 2011;4(2):213–21. 10.1016/j.jcin.2010.09.024
    1. Alessandrino G, Chevalier B, Lefèvre T, Sanguineti F, Garot P, Unterseeh T, et al.. A Clinical and Angiographic Scoring System to Predict the Probability of Successful First-Attempt Percutaneous Coronary Intervention in Patients With Total Chronic Coronary Occlusion. JACC Cardiovasc Interv. Octubre de 2015;8(12):1540–8. 10.1016/j.jcin.2015.07.009
    1. Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, et al.. Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv. 11 de Enero de 2016;9(1):1–9. 10.1016/j.jcin.2015.09.022
    1. Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, et al.. Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score. JACC Cardiovasc Interv. 25 de Febrero de 2019;12(4):335–42. 10.1016/j.jcin.2018.11.020
    1. Amat-Santos IJ, Martin-Yuste V, Fernández-Díaz JA, Martin-Moreiras J, Caballero-Borrego J, Salinas P, et al.. Procedural, Functional and Prognostic Outcomes Following Recanalization of Coronary Chronic Total Occlusions. Results of the Iberian Registry. Rev Esp Cardiol Engl Ed. 1 de Mayo de 2019;72(5):373–82. 10.1016/j.rec.2018.05.020
    1. Kalogeropoulos AS, Alsanjari O, Keeble TR, Tang KH, Konstantinou K, Katsikis A, et al.. Comparison of the novel EuroCTO (CASTLE) score with the J-CTO score for predicting technical success of chronic total occlusions percutaneous revascularization. EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 02 de 2019;
    1. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. septiembre de 1988;44(3):837–45.
    1. Pencina MJ, D’Agostino RB, D’Agostino RB, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 30 de Enero de 2008;27(2):157–72; discussion 207–212. 10.1002/sim.2929
    1. Safari S, Baratloo A, Elfil M, Negida A. Evidence Based Emergency Medicine; Part 5 Receiver Operating Curve and Area under the Curve. Emergency. 2016;4(2):111–3.
    1. Wyman RM. Do We Need Another Predictive Scoring Tool for Chronic Total Occlusion Percutaneous Coronary Intervention? JACC Cardiovasc Interv. Octubre de 2015;8(12):1549–51. 10.1016/j.jcin.2015.08.010
    1. Christopoulos G, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi W, Grantham JA, et al.. Clinical Utility of the Japan-Chronic Total Occlusion Score in Coronary Chronic Total Occlusion Interventions: Results from a Multicenter Registry. Circ Cardiovasc Interv. Julio de 2015;8(7):e002171. 10.1161/CIRCINTERVENTIONS.114.002171
    1. Tanaka H, Morino Y, Abe M, Kimura T, Hayashi Y, Muramatsu T, et al.. Impact of J-CTO score on procedural outcome and target lesion revascularisation after percutaneous coronary intervention for chronic total occlusion: a substudy of the J-CTO Registry (Multicentre CTO Registry in Japan). EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 22 de Enero de 2016;11(9):981–8.
    1. Azzalini L, Ojeda S, Karatasakis A, Maeremans J, Tanabe M, La Manna A, et al.. Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not. Can J Cardiol. Marzo de 2018;34(3):310–8. 10.1016/j.cjca.2017.12.016
    1. Tajti P, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, et al.. In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv. Marzo de 2019;12(3):e007338. 10.1161/CIRCINTERVENTIONS.118.007338
    1. Nikolakopoulos I, Choi JW, Khatri JJ, Alaswad K, Doing AH, Dattilo P, et al.. Follow-up Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With and Without Prior Coronary Artery Bypass Graft Surgery: Insights From the PROGRESS-CTO Registry. J Invasive Cardiol. agosto de 2020;32(8):315–20.
    1. Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, et al.. Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention. Int J Cardiol. 1 de Diciembre de 2016;224:50–6. 10.1016/j.ijcard.2016.08.317
    1. Cook NR. Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation. 20 de Febrero de 2007;115(7):928–35. 10.1161/CIRCULATIONAHA.106.672402
    1. Leening MJG, Vedder MM, Witteman JCM, Pencina MJ, Steyerberg EW. Net Reclassification Improvement: Computation, Interpretation, and Controversies: A Literature Review and Clinician’s Guide. Ann Intern Med. 21 de Enero de 2014;160(2):122–31. 10.7326/M13-1522
    1. Luis Nombela-Franco, Marina Urena, Miguel Jerez-Valero, Nguyen Can Manh Ribeiro Henrique Barbosa, Yoann Bataille, et al.. Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort. Circ Cardiovasc Interv. 1 de Diciembre de 2013;6(6):635–43. 10.1161/CIRCINTERVENTIONS.113.000447
    1. Maeremans J, Spratt JC, Knaapen P, Walsh S, Agostoni P, Wilson W, et al.. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 01 de 2018;91(2):192–202. 10.1002/ccd.27092
    1. Galassi AR, Boukhris M, Azzarelli S, Castaing M, Marzà F, Tomasello SD. Percutaneous Coronary Revascularization for Chronic Total Occlusions: A Novel Predictive Score of Technical Failure Using Advanced Technologies. JACC Cardiovasc Interv. 09 de 2016;9(9):911–22. 10.1016/j.jcin.2016.01.036
    1. Opolski MP, Achenbach S, Schuhbäck A, Rolf A, Möllmann H, Nef H, et al.. Coronary computed tomographic prediction rule for time-efficient guidewire crossing through chronic total occlusion: insights from the CT-RECTOR multicenter registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization). JACC Cardiovasc Interv. Febrero de 2015;8(2):257–67. 10.1016/j.jcin.2014.07.031
    1. Yu C-W, Lee H-J, Suh J, Lee N-H, Park S-M, Park TK, et al.. Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion: Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Imaging. Abril de 2017;10(4). 10.1161/CIRCIMAGING.116.005800

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