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Comparison among Different Scoring Systems in Predicting Procedural Success and Long-Term Outcomes after Percutaneous
Artis Kalnins1, Ieva Strele2, Aivars Lejnieks3,4
1Clinic of Cardiovascular diseases, Riga East University Hospital, Riga, LV 1038, Latvia. artis.kalnins@aslimnica.lv.
Insights
Four scoring systems moderately predict procedural success in chronic total coronary artery occlusions (CTO) percutaneous coronary intervention (PCI). PROGRESS CTO and CASTLE scores identify patients with worse long-term survival after successful PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Chronic total coronary artery occlusions (CTO) require complex percutaneous coronary intervention (PCI).
- Various scoring systems exist to predict PCI success, but their comparative performance and impact on long-term outcomes are not well-established.
- Accurate risk stratification is crucial for managing CTO patients.
Purpose of the Study:
- To evaluate the predictive ability of four CTO scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) for procedural success in PCI.
- To assess the association of these scores with long-term all-cause mortality after successful CTO PCI.
Main Methods:
- Retrospective analysis of 551 patients undergoing elective CTO PCI from 2007-2016.
- Calculation and comparison of J CTO, PROGRESS CTO, CL, and CASTLE scores.
- Receiver operating characteristic (ROC) curve analysis for procedural success prediction.
- Kaplan-Meier and Cox regression analyses for long-term survival assessment.
Main Results:
- Procedural success was achieved in 454 out of 551 cases.
- All scoring systems demonstrated a significant inverse correlation between complexity score and procedural success (p < 0.001).
- The J CTO score showed the highest predictive accuracy for procedural success (AUC = 0.714).
- During a median 6.8-year follow-up, the PROGRESS CTO and CASTLE scores were significantly associated with increased all-cause mortality risk in patients with successful PCI.
- High PROGRESS CTO scores (HR 1.81) and high/intermediate CASTLE scores (HR 3.68/2.15) predicted significantly higher mortality risk.
Conclusions:
- All evaluated CTO scoring systems offer moderate predictive capability for procedural success.
- The PROGRESS CTO and CASTLE scoring systems are valuable for identifying CTO patients at higher risk of long-term mortality following successful PCI.
- J CTO and CL scores did not demonstrate an association with long-term survival outcomes.
Abstract:
Background and objectives: Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure. Materials and Methods: A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan-Meier method and Cox regression were used to estimate the association with death from any cause after a successful procedure, Results: 454 of 551cases were successful. With increasing disease complexity, the procedural success rate was significantly reduced in all scoring systems (p < 0.001): Area under the curve was 0.714 for J CTO score, 0.605 for PROGRESS CTO, 0.624 for CL and 0.641 for CASTLE scores. During the median 6.8 years of follow-up time, survival was better in the successful procedure group (p = 0.041). Among patients with procedural success, only PROGRESS and CASTLE scores showed an association with all-cause risk of death. After adjustment for baseline characteristics, patients having high PROGRESS score had almost twice higher risk of death (HR 1.81(95% CI 1.19-2.75)), and those with high and intermediate CASTLE score experienced almost four (HR 3.68(95% CI 1.50-9.05)) and two (HR 2.15, (95% CI 1.42-3.23)) times higher risk of death than the low score patients, respectively. Conclusions: All four CTO scoring systems had moderate ability to predict procedural success. More complex CTO PCI patients, assessed by PROGRESS and CASTLE scores, has worse all-cause survival in six to seven years after a successful procedure; whereas J CTO and CL scores had no association with survival.
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