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CT Angiography-Derived RECHARGE Score Predicts Successful Percutaneous Coronary Intervention in Patients with Chronic
Jiahui Li1, Rui Wang2, Christian Tesche3,4
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China.
Insights
The non-invasive RECHARGECCTA score accurately predicts 30-minute guidewire crossing in chronic total occlusion percutaneous coronary intervention (CTO-PCI). While comparable to other scores for procedural success, it offers an improved non-invasive alternative for predicting wire crossing outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains challenging.
- Accurate pre-procedural assessment is crucial for successful CTO-PCI.
- Existing scoring systems often rely on invasive methods.
Purpose of the Study:
- To evaluate the accuracy of the coronary CT angiography (CCTA)-derived Registry of Crossboss and Hybrid procedures (RECHARGE) score (RECHARGECCTA) in predicting CTO-PCI success.
- To compare the RECHARGECCTA score with the invasive RECHARGE score (RECHARGECA) and other CCTA-based scores.
Main Methods:
- Retrospective analysis of 124 patients with 131 CTO lesions undergoing CCTA before CTO-PCI.
- Calculation and comparison of RECHARGECCTA scores with RECHARGECA, J-CTO, CT-RECTOR, and KCCT scores.
- Assessment of predictive performance using procedural success and 30-minute guidewire crossing as endpoints.
Main Results:
- Procedural success rate was 72%, with 61% achieving 30-minute wire crossing.
- RECHARGECCTA showed no significant difference from RECHARGECA for procedural success (AUC 0.718 vs. 0.757).
- RECHARGECCTA demonstrated superior prediction for 30-minute wire crossing compared to RECHARGECA (p=0.001) and comparable performance to other CCTA scores.
Conclusions:
- The non-invasive RECHARGECCTA score is a valuable tool for predicting 30-minute guidewire crossing in CTO-PCI.
- It offers an accurate, non-invasive alternative to invasive assessments for this specific outcome.
- While promising, the RECHARGECCTA score may not entirely replace existing CCTA-based scores for predicting overall procedural success.
Objective:
To investigate the feasibility and the accuracy of the coronary CT angiography (CCTA)-derived Registry of Crossboss and Hybrid procedures in France, the Netherlands, Belgium and United Kingdom (RECHARGE) score (RECHARGECCTA) for the prediction of procedural success and 30-minutes guidewire crossing in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
Materials And Methods:
One hundred and twenty-four consecutive patients (mean age, 54 years; 79% male) with 131 CTO lesions who underwent CCTA before catheter angiography (CA) with CTO-PCI were retrospectively enrolled in this study. The RECHARGECCTA scores were calculated and compared with RECHARGECA and other CTA-based prediction scores, including Multicenter CTO Registry of Japan (J-CTO), CT Registry of CTO Revascularisation (CT-RECTOR), and Korean Multicenter CTO CT Registry (KCCT) scores.
Results:
The procedural success rate of the CTO-PCI procedures was 72%, and 61% of cases achieved the 30-minutes wire crossing. No significant difference was observed between the RECHARGECCTA score and the RECHARGECA score for procedural success (median 2 vs. median 2, p = 0.084). However, the RECHARGECCTA score was higher than the RECHARGECA score for the 30-minutes wire crossing (median 2 vs. median 1.5, p = 0.001). The areas under the curve (AUCs) of the RECHARGECCTA and RECHARGECA scores for predicting procedural success showed no statistical significance (0.718 vs. 0.757, p = 0.655). The sensitivity, specificity, positive predictive value, and the negative predictive value of the RECHARGECCTA scores of ≤ 2 for predictive procedural success were 78%, 60%, 43%, and 87%, respectively. The RECHARGECCTA score showed a discriminative performance that was comparable to those of the other CTA-based prediction scores (AUC = 0.718 vs. 0.665-0.717, all p > 0.05).
Conclusion:
The non-invasive RECHARGECCTA score performs better than the invasive determination for the prediction of the 30-minutes wire crossing of CTO-PCI. However, the RECHARGECCTA score may not replace other CTA-based prediction scores for predicting CTO-PCI success.
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