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Validation of the newly introduced CASTLE Score for predicting successful CTO recanalization
Jan-Erik Guelker1,2, Yoshihisa Kinoshita3, Joachim Weber-Albers4
1Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany.
Insights
The new EuroCTO CASTLE score shows similar effectiveness to the J-CTO score in predicting successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). This validation supports its use in complex coronary CTO PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary chronic total occlusions (CTO) pose challenges in percutaneous coronary intervention (PCI).
- Predictive scores aid in assessing technical success for CTO PCI.
- The Japanese Multicenter CTO Registry (J-CTO) score is widely adopted.
Purpose of the Study:
- To validate the new EuroCTO CASTLE score against the established J-CTO score.
- To evaluate the predictive performance of the CASTLE score for technical success in CTO PCI.
- To assess the clinical outcomes and procedural characteristics associated with CTO PCI using these scores.
Main Methods:
- Retrospective analysis of 463 patients undergoing CTO PCI.
- Comparison of CASTLE and J-CTO scores using receiver operating characteristic (ROC) analysis.
- Evaluation of technical success rates, safety endpoints, and clinical symptom improvement.
- Analysis of procedural parameters including fluoroscopy time and contrast use.
Main Results:
- Overall technical success rate was 83.2% with low 30-day adverse events.
- CASTLE and J-CTO scores demonstrated comparable discriminatory performance (AUCs 0.668 vs 0.692, p=0.324).
- Performance remained comparable in complex CTO PCI cases (AUCs 0.514 vs 0.617, p=0.211).
- Higher scores correlated with increased procedural time, contrast volume, and radiation dose.
Conclusions:
- The EuroCTO CASTLE score exhibits comparable predictive performance to the J-CTO score for technical outcomes in CTO PCI.
- The CASTLE score is a valid tool for predicting success in complex coronary CTO interventions.
- Findings support the utility of the CASTLE score in guiding CTO PCI strategies.
Background:
The new EuroCTO CASTLE Score was validated against the widely adopted Japanese Multicenter CTO Registry (J-CTO) score in predicting technical success in percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO).
Methods:
A total of 463 patients treated by CTO PCI were included in a retrospective analysis. Result: The mean CASTLE score was 2.23 ± 1.1 and J-CTO score was 2.84 ± 1.0. The overall technical success rate was 83.2%. At 30 days follow up, a primary composite safety endpoint showed a low proportion of stent thrombosis (0.2%) and re-hospitalization (0.4%). Moreover, an improvement of clinical symptoms was found in 83% of patients. Receiver operating characteristic analysis (ROC) demonstrated a comparable overall discriminatory performance in predicting technical outcome: CASTLE score, area under the ROC curve (AUC) 0.668, 95% CI: 0.606-0.730; J-CTO score AUC 0.692, 95% CI: 0.631-0.752; Comparison of AUCs: p = 0.324. Those findings were even consistent in more complex procedures CASTLE Score ≥ 4 and J-CTO score ≥ 3: CASTLE Score AUC 0.514, 95% CI: 0.409-0.619; J-CTO score, AUC 0.617, 95% CI: 0.493-0.741; Comparison of AUCs: p = 0.211. Furthermore, increasing score values are accompanied by a longer examination and fluoroscopy time, more contrast medium and a higher dose area product.
Conclusion:
Compared to the widely accepted J-CTO score, the new introduced EuroCTO CASTLE score demonstrated a comparable overall discriminatory performance in predicting technical outcomes in CTO PCI.
