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The impact of J-CTO score on in-stent chronic total occlusion percutaneous coronary intervention
Minglian Gong1,2, Tao An3, Yi Mao3
1Department of Cardiology, Dalian University Affiliated Zhongshan Hospital, Dalian, China.
Insights
The J-CTO score does not predict technical success or long-term outcomes for in-stent chronic total occlusion percutaneous coronary intervention. However, factors like vessel tortuosity and long-term dual antiplatelet therapy influence patient results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusions (CTOs) present significant challenges in percutaneous coronary intervention (PCI).
- In-stent CTOs (IS-CTOs) are particularly complex subsets requiring specialized techniques.
- Predictive scoring systems aim to stratify risk and guide procedural strategy for CTO PCI.
Purpose of the Study:
- To evaluate the predictive value of the Japan-Chronic Total Occlusion (J-CTO) score for technical success in IS-CTO PCI.
- To determine the correlation between the J-CTO score and long-term clinical outcomes (major adverse cardiovascular events [MACE]) after IS-CTO PCI.
Main Methods:
- Retrospective analysis of 474 patients undergoing difficult IS-CTO PCI (January 2015 - December 2018).
- Primary endpoint: MACE (target-vessel MI, cardiac death, or ischemia-driven TVR).
- Youden index used for cut-off point estimation; multivariable analysis for predictors of technical success and MACE.
Main Results:
- Overall procedural success rate was 77.6%.
- Factors like proximal bending, tortuosity, stent under-expansion, and poor distal landing zone predicted technical failure, but the J-CTO score did not (P=.124).
- Long-term dual antiplatelet therapy (>18 months) was an independent predictor of decreased MACE risk (HR: 2.690; P=.005), while the J-CTO score did not predict MACE (P=.917).
Conclusions:
- The J-CTO score is not a reliable predictor for technical success in difficult IS-CTO PCI via antegrade approach.
- The J-CTO score does not correlate with long-term MACE in patients undergoing IS-CTO PCI.
- Factors such as vessel tortuosity and prolonged dual antiplatelet therapy are significant for procedural success and long-term outcomes, respectively.
Aim:
The purpose of this study was to investigate the impact of J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) score on in-stent chronic total occlusion (IS-CTO) percutaneous coronary intervention (PCI).
Methods:
A retrospective data collection was conducted on 474 patients undergoing a difficult IS-CTO PCI from January 2015 to December 2018. The primary endpoint (major adverse cardiovascular events [MACE]) consisted of target-vessel myocardial infarction (MI), cardiac death or ischemia-driven target-vessel revascularisation (TVR) at follow-up. The cut-off points were estimated by the Youden index.
Results:
The overall procedural success rate was 77.6%. On multivariable analysis, factors including proximal bending (beta coefficient [β] = 3.465), tortuosity (β = 3.064), stent under expansion (β = 3.109) and poor distal landing zone (β = 1.959) were associated with technical failure via antegrade approach but not the J-CTO score (OR = 0.632; 95% CI [0.352-1.134]; P = .124). After a median follow-up of 30 months (interquartile range: 17-42 months), multivariable analysis revealed that receiving >18 months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of MACE (HR: 2.690; 95% CI: 1.346-5.347; P = .005). But the J-CTO score was not an independent predictor of MACE (HR: 1.018; 95% CI: 0.728-1.424; P = .917).
Conclusions:
J-CTO score system is not a helpful tool to predict the technical success of difficult IS-CTO PCI via antegrade approach, nor does it correlate with long-term outcomes in patients undergoing IS-CTO PCI. Nevertheless, factors associated with technical failure include proximal bending of ≥30 degrees, under expansion of ≥10 mm, moderate or severe tortuosity (bending) ≥20 and poor distal target. Long-term DAPT therapy contributes significantly to decreased MACE.
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