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Multicenter Study
. 2025 Jul:76:66-72.
doi: 10.1016/j.carrev.2024.10.007. Epub 2024 Oct 28.

Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic difficulty scores in the PROGRESS-CTO registry

Deniz Mutlu  1 , Bahadir Simsek  2 , Athanasios Rempakos  1 , Michaella Alexandrou  1 , Ahmed Al-Ogaili  1 , Lorenzo Azzalini  3 , Stephane Rinfret  4 , Jaikirshan J Khatri  5 , Khaldoon Alaswad  6 , Farouc A Jaffer  7 , Wissam Jaber  4 , Mir B Basir  6 , Omer Goktekin  8 , Sevket Gorgulu  9 , Oleg Krestyaninov  10 , Dmitrii Khelimskii  10 , Rhian Davies  11 , Jarrod Frizzel  12 , James W Choi  13 , Raj H Chandwaney  14 , Srinivasa Potluri  15 , Paul Poommipanit  16 , Barry Uretsky  17 , Luiz F Ybarra  18 , Bilal Murad  1 , Bavana V Rangan  1 , Olga C Mastrodemos  1 , Yader Sandoval  1 , M Nicholas Burke  1 , Emmanouil S Brilakis  19
Affiliations
Multicenter Study

Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic difficulty scores in the PROGRESS-CTO registry

Deniz Mutlu et al. Cardiovasc Revasc Med. 2025 Jul.

Abstract

Background: The J-CTO investigators recently developed angiographic difficulty scores for each of the three major coronary arteries in patients undergoing first-attempt chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in de novo occlusions.

Methods: We examined the performance of the individual J-CTO scores in a large multicenter registry.

Results: The CTO lesion location was as follows: right coronary artery (RCA) 3,805 (54%), left anterior descending artery (LAD) 2,303 (33%), and left circumflex (LCX) 935 (13%). Patients in the PROGRESS-CTO registry were younger, more likely to be female, and had higher J-CTO scores compared with the J-CTO registry. Increasing difficulty scores were associated with lower technical success in the PROGRESS-CTO registry (score 0: 94.4 % - score ≥3: 82.6% for the RCA difficulty score; score 0: 96.4% - score ≥3: 86.1 for the LAD difficulty score; and score 0: 95.4% - score ≥3: 81.2% for the LCX difficulty score). The C-statistic of the coronary artery specific J-CTO scores in the PROGRESS-CTO registry were: LAD 0.69 (95% confidence intervals [CI], 0.64-0.73), LCX 0.63 (95% CI, 0.57-0.69), and RCA 0.61 (95-% CI, 0.58-0.64) with good calibration (Hosmer-Lemeshow p-value >0.05 for all). The AUC of the classic J-CTO score for LAD lesions was similar with the LAD J-CTO score (p-for-difference = 0.26), but worse for LCX (p-for-difference = 0.04) and RCA lesions (p-for-difference = 0.04).

Conclusion: In the PROGRESS-CTO registry, the coronary artery specific J-CTO scores did not improve prediction of the technical success of CTO-PCI compared with the classic J-CTO score.

Keywords: CTO; J-CTO; PCI; Validation.

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Conflict of interest statement

Declaration of competing interest Dr. Azzalini: consulting/speaker honoraria from Abbott, Teleflex, GE Healthcare, Reflow Medical, Cardiovascular Systems Inc., Abiomed, serving as advisory board member in Abiomed and GE Healthcare. Dr. Rinfret: consultant for Boston Scientific, Teleflex, Abbott Vascular, Biotronik, and SoundBite Medical. Dr. Khatri: personal honoraria for proctoring and speaking from Abbott Vascular, Medtronic, Terumo, Shockwave, and Boston Scientific. Dr. Alaswad: consulting/speaker honoraria from Boston Scientific, Abbott Vascular, Teleflex, and CSI. Dr. Jaffer: consulting/speaker honoraria from Canon, Biotronik, Teleflex, Boston Scientific, Heartflow, Siemens, Mercator, shareholder: Fastwave, DurVena, Intravascular Imaging Inc. Dr. Jaber: advisory board of Medtronic and reports proctoring fees from Abbott. Dr. Nicholson: proctor, speakers' bureau and advisory board for Abbott Vascular, Boston Scientific, and Asahi Intecc; and intellectual property with Vascular Solutions. Dr. Basir: consulting/speaker honoraria from Abiomed, Boston Scientific, Chiesi, Saranas, Zoll. Dr. Davies: consulting/speaker honoraria from Abiomed, Boston Scientific, Medtronic, Shockwave, Asahi Intec, Avinger, Teleflex. Dr. Frizzel: consulting/speaker honoraria from Shockwave, Asahi Intec, Boston Scientific, Teleflex. Dr. Choi: advisory board member of Medtronic. Dr. Potluri: consulting/speaker honoraria from Edwards Lifesciences, Boston Scientific, Philips, Shockwave. Dr. Poommipanit: consulting/speaker honoraria from Abbott Diagnostics, Asahi. Dr. Sandoval: consulting/speaker honoraria from Abbott Diagnostics, Roche Diagnostics, Zoll, Philips. JACC Advances associate editor. Patent 20,210,401,347. Dr. Burke: consulting and received speaker honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, and Teleflex; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health, Stallion Medical.

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