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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Predicting Successful Recanalization in Patients with Native Coronary Chronic Total Occlusion: The Busan CTO Score
Cai De Jin1, Moo Hyun Kim, Soo Jin Kim
1Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
Insights
The new Busan single-center CTO registry (B-CTO) score effectively predicts successful recanalization for chronic total occlusion (CTO) in Korean patients. This score improves upon existing methods by incorporating clinical and angiographic factors for better patient management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Informatics
Background:
- Optimal management strategies for chronic total occlusion (CTO) are still under investigation.
- The Japanese CTO (J-CTO) score aids in predicting successful recanalization but omits nonangiographic factors.
- A novel scoring system is needed to enhance prediction accuracy for CTO interventions.
Purpose of the Study:
- To develop and validate the Busan single-center CTO registry (B-CTO) score.
- To integrate clinical and angiographic predictors for improved CTO recanalization success prediction.
- To assess the B-CTO score's performance in a Korean patient cohort.
Main Methods:
- A prospective registry of 438 CTO patients undergoing coronary intervention from 1999-2015.
- The B-CTO score incorporates predictors like age, gender, lesion length, location, stump type, and bending angle.
- Patients were categorized into four groups (easy, intermediate, difficult, very difficult) based on their B-CTO score.
Main Results:
- The overall B-CTO success rate was 81.1%.
- Recanalization success probabilities varied significantly across B-CTO score categories (95.3% for easy to 65.2% for very difficult).
- The B-CTO score demonstrated superior predictive discrimination compared to the J-CTO score (AUC 0.083 improvement).
Conclusions:
- The B-CTO score is a validated and improved tool for predicting successful recanalization in native coronary CTO among Korean patients.
- The B-CTO score offers enhanced predictive accuracy by combining clinical and angiographic data.
- Further research is warranted to explore the broader applicability of the B-CTO score.
Background:
The optimal strategy to manage chronic total occlusion (CTO) remains unclear. The Japanese CTO multicenter registry (J-CTO) score is an established tool for predicting successful recanalization. However, it does not take into account nonangiographic predictors for final technique success. In the present study, we designed and tested a scoring model called the Busan single-center CTO registry (B-CTO) score combining clinical and angiographic characteristics to predict successful CTO recanalization in Korean patients.
Methods:
Prospectively enrolled CTO patients (n = 438) undergoing coronary intervention (1999-2015) were assessed. The B-CTO score comprises 6 independent predictors: age 60-74 years and lesion length ≥20 mm were assigned 1 point each, while age ≥75 years, female gender, lesion location in the right coronary artery, blunt stump, and bending >45° were assigned 2 points each. For each predictor, the points assigned were based on the associated odds ratio by multivariate analysis. The lesions were classified into 4 groups according to the summation of points scored to assess the probability of successful CTO recanalization: easy (score 0-1), intermediate (score 2-3), difficult (score 4-5), and very difficult (score ≥6). CTO opening was designated as the primary endpoint regardless of the interventional era or the skill of the operator.
Results:
The final success rate for B-CTO was 81.1%. The probability of successful recanalization for patient groups classified as easy (n = 64), intermediate (n = 148), difficult (n = 134), and very difficult (n = 92) was 95.3, 86.5, 79.1 and 65.2%, respectively (p for trend <0.001). When compared to the J-CTO, the B-CTO score demonstrated a significant improvement in discrimination as indicated by the area under the receiver-operator characteristic curve (AUC 0.083; 95% CI 0.025-0.141), with a positive integrated discrimination improvement of 0.042 and a net reclassification improvement of 56.0%.
Conclusions:
The B-CTO score has been designed and validated in Korean patients with native coronary CTO and is an improved tool for predicting successful recanalization. Wider application of the B-CTO score remains to be explored.
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