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Comparative Study
. 2021 Apr 2;16(4):e0245898.
doi: 10.1371/journal.pone.0245898. eCollection 2021.

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

Pablo Salinas  1 , Nieves Gonzalo  1 , Víctor H Moreno  1 , Manuel Fuentes  2 , Sandra Santos-Martinez  3 , José Antonio Fernandez-Diaz  4 , Ignacio J Amat-Santos  3 , Francisco Bosa Ojeda  5 , Juan Caballero Borrego  6 , Javier Cuesta  7 , José María de la Torre Hernández  8 , Alejandro Diego-Nieto  9 , Daniela Dubois  10 , Guillermo Galeote  11 , Javier Goicolea  4 , Alejandro Gutiérrez  12 , Miriam Jiménez-Fernández  6 , Jesús Jiménez-Mazuecos  13 , Alfonso Jurado  11   14 , Javier Lacunza  15 , Dae-Hyun Lee  8 , María López  16 , Fernando Lozano  14 , Javier Martin-Moreiras  9 , Victoria Martin-Yuste  17 , Raúl Millán  10 , Gema Miñana  18 , Mohsen Mohandes  19 , Francisco J Morales-Ponce  20 , Julio Núñez  18 , Soledad Ojeda  21 , Manuel Pan  21 , Fernando Rivero  7 , Javier Robles  22 , Sergio Rodríguez-Leiras  23 , Sergio Rojas  19 , Juan Rondán  24 , Eva Rumiz  25 , Manel Sabaté  17 , Juan Sanchís  18 , Beatriz Vaquerizo  10 , Javier Escaned  1
Affiliations
Comparative Study

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

Pablo Salinas et al. PLoS One. .

Abstract

Background: We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.

Methods: Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.

Results: Mean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, p<0.001), similar to J-CTO and slightly inferior to CL score (- 0.011, p = 0.004). Regarding net reclassification improvement, CASTLE reclassified better than PROGRESS (overall continuous net reclassification improvement 0.379, p<0.001) in roughly 20% of cases.

Conclusion: Procedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

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Conflict of interest statement

Abbott provided an unrestricted grant to support the Registry and this publication’s fees. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Barchart of scoring distribution.
The study population scoring distribution (n = 1342 CTOs) is shown in blue. Original derivation cohort scoring distribution is shown in gray, but for CL score (not available in original publication). Note that 0.5 and 7.5 are not possible to be obtained in CL-score.
Fig 2
Fig 2. Expected success rates versus observed success rates across different strata of each score.
P values for linear trend and Hosmer-Lemeshow (HL) tests are provided.
Fig 3
Fig 3. ROC curve and AUC of each score discriminating procedural success.
Comparison between AUCs were done taking CASTLE score as a reference.
See this image and copyright information in PMC

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