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Published on: April 17, 2021
Outcomes after percutaneous coronary intervention and comparison among scoring systems in predicting procedural
Ya-Min Su1, Min Pan2, Hai-Hua Geng2
1Department of Cardiology, School of Medicine, Southeast University, Nanjing.
Insights
Percutaneous coronary intervention (PCI) for elderly patients with chronic total occlusion (CTO) is feasible and safe, despite a lower procedural success rate. The J-CTO, PROGRESS CTO, ORA, and CL scoring systems demonstrate moderate predictive capacity for PCI outcomes in this population.
Area of Science:
- Interventional Cardiology
- Geriatric Cardiovascular Medicine
Background:
- Limited evidence exists for percutaneous coronary intervention (PCI) in elderly patients with chronic total occlusion (CTO).
- Comparative data on scoring systems for predicting PCI outcomes in this demographic are scarce.
Purpose of the Study:
- To evaluate the feasibility and safety of PCI in elderly patients (≥75 years) with CTO.
- To compare the predictive capacity of four scoring systems (J-CTO, PROGRESS CTO, CL, ORA) for procedural success in elderly CTO patients.
Main Methods:
- A retrospective study of 246 consecutive CTO patients, stratified into elderly (≥75 years) and non-elderly (<75 years) groups.
- Analysis of clinical and angiographic characteristics, procedural success rates, and in-hospital major adverse cardiac events.
- Evaluation of the predictive performance of J-CTO, PROGRESS CTO, CL, and ORA scores using area under the curve (AUC).
Main Results:
- Elderly patients had higher rates of triple-vessel disease and Synergy Between PCI With TAXUS and Cardiac Surgery scores.
- In-hospital MACE, vascular access complications, and major bleeding rates were similar between groups.
- Procedural success rates were significantly lower in the elderly group (73.53% vs. 84.83%).
- All four scoring systems showed moderate predictive capacity (AUCs ranging from 0.672 to 0.806).
- J-CTO and CL scores demonstrated a significant advantage over the ORA score in predicting procedural success.
Conclusions:
- PCI in elderly patients with CTO is feasible and safe, despite a lower procedural success rate.
- The J-CTO, PROGRESS CTO, ORA, and CL scoring systems possess moderate discriminatory capacity for predicting PCI outcomes in CTO patients.
- J-CTO and CL scores appear to be more effective predictors of procedural success in this population.
Background:
Evidence-based data on percutaneous coronary intervention in elderly patients with chronic total occlusion (CTO) and comparison among different scoring systems have not been well established.
Patients And Methods:
A total of 246 consecutive patients were stratified into two groups according to the age: elderly group (age≥ 75 years, n = 68) and nonelderly group (age < 75 years, n = 178). Clinical and angiographic characteristics including the Synergy Between PCI With TAXUS and Cardiac Surgery score, in-hospital major adverse cardiac events, procedural success rates, and predictive capacity of four scoring systems [J-CTO, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO), clinical and lesion-related (CL), and ostial location, Rentrop grade < 2, age ≥ 75 years (ORA) scores] were examined.
Results:
Triple-vessel disease and the Synergy Between PCI With TAXUS and Cardiac Surgery score in the elderly group were significantly higher than those in the nonelderly group (73.53 vs. 53.93%, P = 0.005; 31.39 ± 7.68 vs. 27.85 ± 7.16, P = 0.001, respectively). The in-hospital major adverse cardiac event rates, vascular access complication rates, and major bleeding rates were similar between the elderly and the nonelderly group (2.94 vs. 2.25%, P = 0.669; 1.47 vs. 0.56%, P = 0.477; 2.94 vs. 1.12%, P = 0.306, respectively). By contrast, the procedural success rate was statistically lower in the elderly group than that in the nonelderly group (73.53 vs. 84.83%, P = 0.040). All the four scoring systems showed a moderate predictive capacity [area under the curve (AUC) for J-CTO score: 0.806, P < 0.0001; AUC for PROGRESS CTO score: 0.727, P < 0.0001; AUC for CL score: 0.800, P < 0.0001; AUC for ORA score: 0.672, P < 0.0001, respectively]. Compared with the ORA score, the J-CTO score, and the CL score showed a significant advantage in predicting procedural success among overall patients (ΔAUC = 0.134, P = 0.0122; ΔAUC = 0.128, P = 0.0233, respectively).
Conclusion:
Despite the lower procedural success rate, percutaneous coronary intervention in elderly patients with CTO is feasible and safe. J-CTO, PROGRESS, ORA, and CL scoring systems have moderate discriminatory capacity.
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