Angiographic Scoring System for Predicting Successful Percutaneous Coronary Intervention of In-Stent Chronic Total...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• In-stent chronic total occlusion (IS-CTO) poses challenges for percutaneous coronary intervention (PCI).
• Predicting technical success in IS-CTO recanalization is crucial for procedural planning and patient outcomes.
• Existing scoring systems may not fully capture the complexities of IS-CTO PCI.

Purpose of the Study:

• To develop and validate a novel scoring model, the IS-CTO score, for predicting the technical success of antegrade approach PCI in IS-CTO.
• To identify key clinical and angiographic factors associated with technical failure in IS-CTO PCI.
• To compare the predictive performance of the IS-CTO score against established scoring systems.

Main Methods:

• Retrospective analysis of 474 patients undergoing antegrade IS-CTO PCI.
• Development of a scoring system based on multivariable analysis of factors correlated with technical failure.
• Validation of the IS-CTO score using a derivation and validation cohort (4:1 ratio).
• Comparison of the IS-CTO score with the Japanese chronic total occlusion (J-CTO) and PROGRESS CTO scores.

Main Results:

• The overall procedural success rate was 77.4%.
• Factors predicting technical failure included proximal bending, tortuosity, stent under-expansion, and poor distal landing zone.
• The IS-CTO score demonstrated excellent predictive capacity and calibration in both derivation and validation cohorts (ROC AUC > 0.97).
• The IS-CTO score significantly outperformed the J-CTO and PROGRESS CTO scores in predicting technical success.

Conclusions:

• The developed IS-CTO score is a reliable and accurate tool for predicting technical success in IS-CTO PCI via the antegrade approach.
• The IS-CTO score offers superior predictive performance compared to existing scores, aiding in procedural planning and risk stratification.
• This scoring system can assist interventional cardiologists in optimizing patient selection and strategy for IS-CTO interventions.