Related Experiment Video
Updated: Jun 8, 2025
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic
Deniz Mutlu1, Bahadir Simsek2, Athanasios Rempakos1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Insights
The J-CTO scores for specific coronary arteries did not improve predicting chronic total occlusion percutaneous coronary intervention success compared to the classic score. This finding is crucial for optimizing PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- The J-CTO score was developed to predict technical success in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Coronary artery-specific J-CTO scores were created for the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex (LCX).
Purpose of the Study:
- To evaluate the performance of individual, coronary artery-specific J-CTO scores in a large, multicenter registry.
- To compare the predictive accuracy of artery-specific J-CTO scores against the classic J-CTO score for CTO-PCI technical success.
Main Methods:
- Analysis of a large multicenter registry (PROGRESS-CTO) of patients undergoing CTO-PCI.
- Examination of the association between J-CTO difficulty scores (classic and artery-specific) and technical success rates.
- Statistical evaluation using C-statistics and AUC to assess predictive performance and calibration.
Main Results:
- Higher J-CTO scores correlated with lower technical success rates across all three coronary arteries (RCA, LAD, LCX).
- Artery-specific J-CTO scores demonstrated moderate predictive ability (C-statistics ranging from 0.61 to 0.69).
- The classic J-CTO score performed similarly to the LAD-specific score but was superior for LCX and RCA lesions.
Conclusions:
- Coronary artery-specific J-CTO scores did not offer improved prediction of technical success in CTO-PCI compared to the classic J-CTO score.
- The findings suggest the classic J-CTO score remains a valuable tool for predicting CTO-PCI outcomes.
Background:
The J-CTO investigators recently developed angiographic difficulty scores for each of the three major coronary arteries in patients undergoing first-attempt chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in de novo occlusions.
Methods:
We examined the performance of the individual J-CTO scores in a large multicenter registry.
Results:
The CTO lesion location was as follows: right coronary artery (RCA) 3,805 (54%), left anterior descending artery (LAD) 2,303 (33%), and left circumflex (LCX) 935 (13%). Patients in the PROGRESS-CTO registry were younger, more likely to be female, and had higher J-CTO scores compared with the J-CTO registry. Increasing difficulty scores were associated with lower technical success in the PROGRESS-CTO registry (score 0: 94.4 % - score ≥3: 82.6% for the RCA difficulty score; score 0: 96.4% - score ≥3: 86.1 for the LAD difficulty score; and score 0: 95.4% - score ≥3: 81.2% for the LCX difficulty score). The C-statistic of the coronary artery specific J-CTO scores in the PROGRESS-CTO registry were: LAD 0.69 (95% confidence intervals [CI], 0.64-0.73), LCX 0.63 (95% CI, 0.57-0.69), and RCA 0.61 (95-% CI, 0.58-0.64) with good calibration (Hosmer-Lemeshow p-value >0.05 for all). The AUC of the classic J-CTO score for LAD lesions was similar with the LAD J-CTO score (p-for-difference = 0.26), but worse for LCX (p-for-difference = 0.04) and RCA lesions (p-for-difference = 0.04).
Conclusion:
In the PROGRESS-CTO registry, the coronary artery specific J-CTO scores did not improve prediction of the technical success of CTO-PCI compared with the classic J-CTO score.
More Related Videos
13:07Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT