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. 2023;30(1):59-67.
doi: 10.5603/CJ.a2021.0058. Epub 2021 Jun 14.

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

Mohsen Mohandes  1 , Cristina Moreno  2 , Sergio Rojas  2 , Victor Doblas  2 , Mónica Fuertes  2 , Francisco Fernández  2 , Alberto Pernigotti  2 , Jordi Guarinos  2 , Mercé Camprubi  3 , Alfredo Bardají  3
Affiliations

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

Mohsen Mohandes et al. Cardiol J. 2023.

Abstract

Background: Several scoring systems have been described to assess the level of difficulty and to predict the probability of success of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). The J-CTO score was initially developed to correlate CTO complexity with guidewire time crossing through the lesion within 30 min. Moreover, almost all scoring systems represent procedures performed by seasoned operators. Herein, this study sought to evaluate the predictive capacity of J-CTO for PCI success in a European single-center cohort with growing experience in the approach of CTO.

Methods: Five hundred twenty-six procedures were performed between 2007 and 2020 mainly by a single operator. The predictive power of J-CTO score was assessed by area under the receiver-operator characteristic curve (ROC) in the entire cohort and additionally in two separate periods. The goodnessof- fit of the model was evaluated by the Hosmer and Lemeshow statistic.

Results: Successful procedure in first-attempt PCI was 79.5% and the overall success including 47 repeated procedures was achieved in 85.8%. The retrograde approach was attempted in 14.4%. The score was inversely associated with procedural success with lower success rate in more difficult CTOs (p < 0.001). ROC curve for the entire cohort, and first block (case 1-200) and second block (case 201-526) was 0.696, 0.661 and 0.748, respectively. The model showed good calibration for the entire cohort (X2 = 1.7; p = 0.43).

Conclusions: J-CTO score showed an acceptable predictive power for procedural success in this cohort although its discriminatory power is better as the level of experience is improved.

Keywords: J-CTO score; chronic total occlusion (CTO); percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Flowchart of patients and percutaneous coronary intervention (PCI) in the entire cohort and procedural result in different steps; CTO — chronic total occlusion.
Figure 2
Figure 2
Procedural success rate corresponding to different blocks of cases (1–100, 101–200, 201–300, 301–400 and > 400 (p of linear trend < 0.001).
Figure 3
Figure 3
Procedural success rate according to different grades of J-CTO in the entire cohort; X2 = 49.4; p < 0.001; p for trend < 0.001.
Figure 5
Figure 5
Receiver operator characteristic curve for successful percutaneous coronary intervention (PCI) in the entire cohort (A), in the first block (case 1–200) (B) and in the second block (case 201–526) (C); CI — confidence interval; CTO — chronic total occlusion.
Figure 4
Figure 4
The result of observed and expected success rate according to J-CTO score in the entire population; Hosmer and Lemeshow (HL) test: X2 = 1.7; p = 0.43.
See this image and copyright information in PMC

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