慢性完全閉塞（CTO）スコアリングシステムが虚血性心疾患の経皮的冠動脈インターベンション（PCI）の成功を予測する上での影響

Chronic total occlusion (CTO) lesions in coronary arteries present a significant challenge, often resulting in referrals for coronary artery bypass graft surgery. Successful percutaneous coronary intervention (PCI) for CTOs demands an accurate assessment of procedural potential. This study aimed to compare the efficacy of different CTO scoring systems in predicting the PCI procedural success and the associated patient complications. It included patients with a CTO in at least one coronary artery who were scheduled for elective PCI based on objective evidence of ischemia. Experienced operators performed the PCI, recorded procedural variables, and assessed complications. Our findings indicated that the J-CTO score had the highest positive predictive value (PPV) at 88.89%, closely followed by the CL CTO score at 88.79%, the CASTLE CTO score at 86.84%, and lastly, the Progress CTO score at 86.51%. All scores fell within an acceptable specificity range of 59.2% to 76.3%, while accuracy varied from 62.61% to 72.52%. We also estimated these values using the best Youden index, which was 0.362 for J-CTO, 0.355 for CASTLE CTO, 0.330 for CL CTO, and 0.283 for Progress CTO, thus maximizing sensitivity and specificity at a particular point. The relation between CTO scores and complications showed comparable differences with no statistical significance and no correlation regarding the cut-off value. This study shows that J-CTO and CASTLE provide slightly greater accuracy in predicting complex CTO PCI success compared to PROGRESS CTO and CL. However, the ORA score did not demonstrate statistical significance in our patients.