Clinical Prediction Score for Successful Retrograde Procedure in Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract

Objective: To develop and validate a prediction score for a successful retrograde procedure in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: A total of 228 CTO lesions in 223 patients who underwent PCI by retrograde approach were analyzed. All subjects were randomly grouped to a derivation set and a validation set at a ratio of 2:1. A successful retrograde procedure was set as the end point. Each of the identified predictors for the end point by logistic regression was assigned 1 point and summed. Results: Independent predictors of a successful retrograde procedure were Werner's score [odds ratio (OR) 4.841, 95% confidence interval (CI) 1.952-12.005, p = 0.001], diameter of distal CTO segment (OR 5.263, 95% CI 2.067-13.398, p < 0.001) and tortuous collateral (type b; OR 0.119, 95% CI 0.032-0.444, p = 0.002). The predictive model developed in the derivation set stratified the difficulty of achieving a successful retrograde procedure into 4 grades - very difficult (10.5%), difficult (23.7%), intermediate (50.7%) and easy (15.1%) - and was demonstrated significantly in the validation set: very difficult (15.8%), difficult (18.4%), intermediate (47.4%) and easy (18.4%). The area under the receiver-operating characteristic curve was 0.832 ± 0.042 for the derivation set and 0.912 ± 0.041 for the validation set with an almost equal performance. Conclusions: According to the experience of our center, this model performed excellently in predicting the difficulty in achieving a successful retrograde procedure.

Epicardial collateral channel for retrograded recanalization of chronic total occlusion percutaneous coronary intervention: Predictors of failure and procedural outcome

“…Information on gender, age, coronary heart disease risk factors, left ventricular ejection fraction (LVEF), history of myocardial infarction (MI), and history of coronary artery bypass graft (CABG) surgery were gathered as baseline data. Data on variables previously described by the J‐CTO (Multicenter CTO Registry in Japan) score, the Progress CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score, and retrograde CTO score were obtained …”

“…Retrograde CTO score contains three variables which are, Werner's score, diameter of distal CTO lesion (<1.5 mm) and tortuous collateral (type b collateral channel). One point is assigned to each of these factors …”

“…Several studies aimed at developing success prediction models have been carried out and the use of classical risk factors including, the length of the occlusion (>20 mm), blunt stump, CTO calcification, CTO tortuosity, and prior failed attempt, have shown good discriminatory capacity on the success of antegrade CTO PCI. There are still some noticeable limitations to CTO‐PCI intervention especially regarding the hybrid approach and retrograde recanalization . One of the key steps of the retrograde technique is to successfully pass the retrograde guidewire and microcatheter through the collateral channels (CCs) .…”

“…Several studies aimed at developing success prediction models have been carried out [10][11][12] and the use of classical risk factors 13 including, the length of the occlusion (>20 mm), blunt stump, CTO calcification, CTO tortuosity, and prior failed attempt, have shown good discriminatory capacity on the success of antegrade CTO PCI.…”

Scoring systems for chronic total occlusion percutaneous coronary intervention: if you fail to prepare you are preparing to fail

“…A key contributor to achieving success in CTO PCI is meticulous preparation; to aid with planning, operators and centers from around the world have created CTO PCI prediction scores (Table 1) (3)(4)(5)(6)(7)(8)(9)(10)(11).…”