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New Angiographic Difficulty Score for First-Attempt Chronic Total Occlusion in the 3 Major Coronary Arteries

Takeshi Niizeki1, Etsuo Tsuchikane2, Tsuneo Konta3

  • 1Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan.

JACC. Cardiovascular Interventions
|October 25, 2023
PubMed

Insights

Predictors for unsuccessful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary across major coronary arteries. A new difficulty score shows promise, comparable to the J-CTO score, for predicting PCI failure.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains challenging due to complex lesion morphology.
  • Success rates for CTO PCI can differ among the three major coronary arteries, influenced by patient and lesion characteristics.

Purpose of the Study:

  • To compare predictors of unsuccessful first-attempt CTO PCI across the left anterior descending, left circumflex, and right coronary arteries.
  • To evaluate a novel difficulty score against the established J-CTO score for predicting PCI failure.

Main Methods:

  • Analysis of 6,408 first-attempt CTO patients from the Japanese CTO-PCI expert registry (2014-2021).
  • Patients were randomly assigned to derivation and validation sets.
  • Development of artery-specific difficulty scores based on predictive factors for unsuccessful PCI.

Main Results:

  • The left circumflex coronary artery had the lowest success rate (90%), followed by the right coronary artery (92%) and left anterior descending artery (94%).
  • Right coronary artery CTO lesions were longer, more angulated, and more frequently required a retrograde approach.
  • Multivariate analysis indicated distinct predictors of PCI failure for each major coronary artery, and the novel RCA CTO difficulty score outperformed the J-CTO score.

Conclusions:

  • Clinical and angiographic variations contribute to differing success rates of CTO PCI among major coronary arteries.
  • A new difficulty score demonstrates comparable performance to the J-CTO score, with superior discriminatory ability for predicting unsuccessful CTO PCI.
Abstract

Keywords:
angiographic difficulty scorechronic total occlusionpercutaneous coronary interventionpredictors for procedural failure

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