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Angiographic Scoring System for Predicting Successful Percutaneous Coronary Intervention of In-Stent Chronic Total
Minglian Gong1,2, Hongyu Peng2, Zheng Wu2
1Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China.
Insights
A new IS-CTO score predicts technical success for in-stent chronic total occlusion (IS-CTO) percutaneous coronary intervention (PCI) via antegrade approach. This scoring system demonstrates superior accuracy compared to existing models.
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.
Abstract:
The purpose of this study was to develop a scoring model to predict the technical success of recanalizing via antegrade approach in-stent chronic total occlusion (IS-CTO) by percutaneous coronary intervention (PCI). We retrospectively collected data from 474 patients who underwent an uneasy IS-CTO PCI via antegrade approach from January 2015 to December 2018, consecutively. We selected clinical and angiographic factors and utilized a derivation and validation cohort (4:1 sampling ratio) analysis. Factors with strong correlations with technical failure, according to multivariable analysis, were assigned 1 point, and a scoring system with a 4-point maximum was established. The model was then validated with a validation cohort. The overall procedural success rate was 77.4%. On multivariable analysis, the factors that correlated with technical failure were proximal bending (beta coefficient [β] = 2.142), tortuosity (β = 2.622), stent under expansion (β = 3.052), and poor distal landing zone (β = 2.004). The IS-CTO score demonstrated good calibration and excellent predicting capacity in the derivation (receiver-operator characteristic [ROC] area = 0.973 and Hosmer-Lemeshow chi-squared = 5.252; p = 0.072) and validation (ROC area = 0.976 and Hosmer-Lemeshow chi-squared = 0.916; p = 0.632) cohorts. In the validation subset, the IS-CTO score demonstrated superior performance to the Japanese chronic total occlusion score (J-CTO) and PROGRESS CTO scores for predicting technical success (area under the a curve [AUC] 0.976 vs. 0.642 vs. 0.579, respectively; difference in AUC between the IS-CTO score and J-CTO score = 0.334, p < 0.01; difference in AUC between the IS-CTO score and PROGRESS score = 0.397, p < 0.01). Our results suggest that the IS-CTO score system is a helpful tool to predict the technical success of IS-CTO PCI via antegrade approach in china. Graphical Abstract.
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