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Comparative validation of risk scores for in-hospital complications following chronic total occlusion percutaneous

Enrico Poletti1, Sudhir Thotakura2, Kathleen E Kearney3

  • 1Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA; Department of Cardiology, Hartcentrum Ziekenhuis aan de Stroom (ZAS) Middelheim, Antwerp, Belgium; Faculty of Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

American Heart Journal
|March 21, 2026
PubMed

Insights

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) score is superior for predicting in-hospital mortality in chronic total occlusion percutaneous coronary intervention (CTO-PCI) compared to the PROGRESS-CTO model. BMC2 offers better accuracy for predicting patient outcomes in this high-risk procedure.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is a complex, high-risk cardiovascular procedure.
  • Accurate prediction of in-hospital outcomes is crucial for patient management and procedural planning in CTO-PCI.

Purpose of the Study:

  • To compare the predictive performance of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) score and the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) model for in-hospital outcomes after CTO-PCI.
  • To evaluate the discrimination and calibration of both risk models.

Main Methods:

  • Retrospective analysis of 1,157 CTO-PCI procedures performed between 2019 and 2023 at a single tertiary center.
  • Primary endpoint: in-hospital mortality. Secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE), acute kidney injury, dialysis, stroke, periprocedural myocardial infarction, pericardiocentesis, and coronary perforation.
  • Model performance assessed using area under the curve (AUC) for discrimination and calibration plots and Brier score for overall accuracy.

Main Results:

  • The BMC2 score demonstrated superior discrimination for in-hospital mortality prediction compared to PROGRESS-CTO (AUC 0.96 vs. 0.71, p<0.001).
  • BMC2 showed excellent predictive accuracy for acute kidney injury (AUC 0.93), dialysis (0.91), and stroke (0.84).
  • PROGRESS-CTO showed moderate accuracy for periprocedural myocardial infarction, pericardiocentesis, coronary perforation, and MACCE. Calibration was better with PROGRESS-CTO, but both models had low overall prediction error.

Conclusions:

  • The BMC2 score is a more effective tool for predicting in-hospital mortality in CTO-PCI procedures.
  • BMC2 is a powerful, data-intensive, patient-focused risk model, while PROGRESS-CTO is a simpler, procedure-oriented model.
  • The findings suggest that BMC2 should be prioritized for mortality risk assessment in CTO-PCI, with PROGRESS-CTO serving as a complementary tool.
Abstract

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