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Review
. 2022 Jan 15:38:100942.
doi: 10.1016/j.ijcha.2021.100942. eCollection 2022 Feb.

Validation of the newly introduced CASTLE Score for predicting successful CTO recanalization

Jan-Erik Guelker  1   2 , Yoshihisa Kinoshita  3 , Joachim Weber-Albers  4 , Alexander Bufe  2   5 , Christian Blockhaus  2   5 , Kambis Mashayekhi  6
Affiliations
Review

Validation of the newly introduced CASTLE Score for predicting successful CTO recanalization

Jan-Erik Guelker et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The new EuroCTO CASTLE Score was validated against the widely adopted Japanese Multicenter CTO Registry (J-CTO) score in predicting technical success in percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO).

Methods: A total of 463 patients treated by CTO PCI were included in a retrospective analysis. Result: The mean CASTLE score was 2.23 ± 1.1 and J-CTO score was 2.84 ± 1.0. The overall technical success rate was 83.2%. At 30 days follow up, a primary composite safety endpoint showed a low proportion of stent thrombosis (0.2%) and re-hospitalization (0.4%). Moreover, an improvement of clinical symptoms was found in 83% of patients. Receiver operating characteristic analysis (ROC) demonstrated a comparable overall discriminatory performance in predicting technical outcome: CASTLE score, area under the ROC curve (AUC) 0.668, 95% CI: 0.606-0.730; J-CTO score AUC 0.692, 95% CI: 0.631-0.752; Comparison of AUCs: p = 0.324. Those findings were even consistent in more complex procedures CASTLE Score ≥ 4 and J-CTO score ≥ 3: CASTLE Score AUC 0.514, 95% CI: 0.409-0.619; J-CTO score, AUC 0.617, 95% CI: 0.493-0.741; Comparison of AUCs: p = 0.211. Furthermore, increasing score values are accompanied by a longer examination and fluoroscopy time, more contrast medium and a higher dose area product.

Conclusion: Compared to the widely accepted J-CTO score, the new introduced EuroCTO CASTLE score demonstrated a comparable overall discriminatory performance in predicting technical outcomes in CTO PCI.

Keywords: CASTLE score; Chronic total occlusion; J-CTO score; Percutaneous coronary intervention.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Relationship of the two scores depending on the different values.
Fig. 2a
Fig. 2a
Success rates of the CASTLE score depending of the different values.
Fig. 2b
Fig. 2b
Success rates of the J-CTO score depending of the different values.
Fig. 3a
Fig. 3a
ROC curve for success prediction for both scores in all patients.
Fig. 3b
Fig. 3b
ROC curve for success prediction for both scores in CABG patients.
See this image and copyright information in PMC

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