CASTLE score versus J-CTO score for the prediction of technical success in chronic total occlusion percutaneous...

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Coronary chronic total occlusions (CTOs) present a challenge for percutaneous coronary intervention (PCI).
• Predictive scoring systems aid in assessing procedural success, guiding clinical decisions.

Purpose of the Study:

• To compare the predictive efficiency of the novel EuroCTO (CASTLE) score against the established Japan CTO (J-CTO) score for CTO PCI success.
• To evaluate the performance of both scores in predicting outcomes for varying complexities of CTOs.

Main Methods:

• A retrospective analysis of 660 consecutive CTO PCI procedures was conducted.
• The Japan CTO (J-CTO) and EuroCTO (CASTLE) scores were calculated for each patient.
• Receiver operating characteristic (ROC) analysis was used to compare the discriminatory capacity of both scores.

Main Results:

• Both J-CTO and EuroCTO (CASTLE) scores demonstrated similar overall predictive capacity (AUC 0.698 vs 0.676).
• For complex CTOs (J-CTO ≥3 or EuroCTO [CASTLE] ≥4), the EuroCTO (CASTLE) score showed superior predictive ability (AUC 0.588 vs 0.473).
• Commonly used techniques included antegrade wire escalation (82%), retrograde approach (37%), and antegrade dissection re-entry (14%).

Conclusions:

• The EuroCTO (CASTLE) score is comparable to the J-CTO score in predicting CTO PCI success.
• The EuroCTO (CASTLE) score offers superior discriminatory capacity for more complex coronary chronic total occlusion interventions.