Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Oct 11;5(10):e004272.
doi: 10.1161/JAHA.116.004272.

Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

Barbara Anna Danek  1 , Aris Karatasakis  1 , Dimitri Karmpaliotis  2 , Khaldoon Alaswad  3 , Robert W Yeh  4 , Farouc A Jaffer  4 , Mitul P Patel  5 , Ehtisham Mahmud  5 , William L Lombardi  6 , Michael R Wyman  7 , J Aaron Grantham  8 , Anthony Doing  9 , David E Kandzari  10 , Nicholas J Lembo  10 , Santiago Garcia  11 , Catalin Toma  12 , Jeffrey W Moses  2 , Ajay J Kirtane  2 , Manish A Parikh  2 , Ziad A Ali  2 , Judit Karacsonyi  1 , Bavana V Rangan  1 , Craig A Thompson  13 , Subhash Banerjee  1 , Emmanouil S Brilakis  14
Affiliations

Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

Barbara Anna Danek et al. J Am Heart Assoc. .

Abstract

Background: High success rates are achievable for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the hybrid approach, but periprocedural complications remain of concern. Although scores estimating success and efficiency in CTO PCI have been developed, there is currently no available score for estimation of the risk for periprocedural complications. We sought to develop a scoring tool for prediction of periprocedural complications during CTO PCI.

Methods and results: We analyzed data from 1569 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) using a derivation and validation sampling ratio of 2:1. Variables independently associated with periprocedural complications in multivariable analysis in the derivation set were assigned points based on their respective odds ratios. Forty-four (2.8%) patients experienced complications. Three factors were independent predictors of complications and were included in the score: patient age >65 years, +3 points (odds ratio, OR=4.85, CI 1.82-16.77); lesion length ≥23 mm, +2 points (OR=3.22, CI 1.08-13.89); and use of the retrograde approach +1 point (OR=2.41, CI 1.04-6.05). The resulting score showed good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow χ2 6.271, P=0.281, receiver-operating characteristic [ROC] area=0.758) and validation (Hosmer-Lemeshow χ2 4.551, P=0.473, ROC area=0.793) sets. Score values of 0 to 2, 3 to 4, and ≥5 were defined as low, intermediate, and high risk of complications (derivation cohort 0.4%, 1.8%, 6.5%, P<0.001; validation cohort 0.0%, 2.5%, 6.8%, P<0.001).

Conclusions: The PROGRESS CTO complication score is a useful tool for prediction of periprocedural complications in CTO PCI.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.

Keywords: chronic total occlusion; complication; outcome; percutaneous coronary intervention; risk stratification.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The PROGRESS CTO complications score. Summary of the PROGRESS CTO complications scoring system and risk groups for the overall cohort (validation cohort+derivation cohort). PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
Figure 2
Figure 2
Comparison of the PROGRESS CTO complications score in the derivation and validation sets. The areas under the curves for the derivation and validation sets are 0.758 (95% CI 0.665‐0.850) and 0.793 (95% CI 0.682‐0.905), respectively. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
Figure 3
Figure 3
Incidence of periprocedural complications in strata of the PROGRESS CTO complications score. The incidence of all complications is represented by the blue bars; the incidence of the most serious complications (death, stroke, and tamponade requiring pericardiocentesis) is represented by the red bars. Differences in the incidence of events among strata were statistically significant in the derivation set, the validation set, and the whole study population. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
Figure 4
Figure 4
Sensitivity and specificity of the PROGRESS CTO complications score in the derivation and validation sets. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
Figure 5
Figure 5
Comparison of the PROGRESS CTO complications score with other scoring systems. The PROGRESS CTO complications score is compared with the J‐CTO score, the PROGRESS CTO score, and the CL score in the validation set. The areas under the curves (AUCs) were PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were as follows: J‐CTO score Δ=0.117, P=0.15; PROGRESS CTO score Δ=0.292, P<0.001; and CL score Δ=0.017, P=0.83. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
See this image and copyright information in PMC

References

    1. Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, Alomar M, Shorrock D, Cipher D, Abdullah S, Banerjee S, Brilakis ES. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta‐analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv. 2013;6:128–136. - PubMed
    1. Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman RM, Lombardi WL, Menon RV, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh M, Green P, Finn M, Garcia S, Doing A, Patel M, Bahadorani J, Tarar MN, Christakopoulos GE, Thompson CA, Banerjee S, Brilakis ES. Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry. Int J Cardiol. 2015;198:222–228. - PMC - PubMed
    1. Galassi AR, Sianos G, Werner GS, Escaned J, Tomasello SD, Boukhris M, Castaing M, Buttner JH, Bufe A, Kalnins A, Spratt JC, Garbo R, Hildick‐Smith D, Elhadad S, Gagnor A, Lauer B, Bryniarski L, Christiansen EH, Thuesen L, Meyer‐Gessner M, Goktekin O, Carlino M, Louvard Y, Lefevre T, Lismanis A, Gelev VL, Serra A, Marza F, Di Mario C, Reifart N; Euro CTO Club . Retrograde recanalization of chronic total occlusions in Europe: procedural, in‐hospital, and long‐term outcomes from the multicenter ERCTO registry. J Am Coll Cardiol. 2015;65:2388–2400. - PubMed
    1. Tanaka H, Morino Y, Abe M, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Morimoto T, Hinohara T, Fujii T, Mitsudo K. Impact of J‐CTO score on procedural outcome and target lesion revascularisation after percutaneous coronary intervention for chronic total occlusion: a substudy of the J‐CTO Registry (Multicentre CTO Registry in Japan). EuroIntervention. 2016;11:981–988. - PubMed
    1. Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Hinohara T, Tanaka H, Mitsudo K; J‐CTO Registry Investigators . Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J‐CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213–221. - PubMed

Publication types

Associated data