The impact of J‐CTO score on in‐stent chronic total occlusion percutaneous coronary intervention

Abstract

Aim The purpose of this study was to investigate the impact of J‐CTO (Multicenter Chronic Total Occlusion Registry of Japan) score on in‐stent chronic total occlusion (IS‐CTO) percutaneous coronary intervention (PCI). Methods A retrospective data collection was conducted on 474 patients undergoing a difficult IS‐CTO PCI from January 2015 to December 2018. The primary endpoint (major adverse cardiovascular events [MACE]) consisted of target‐vessel myocardial infarction (MI), cardiac death or ischemia‐driven target‐vessel revascularisation (TVR) at follow‐up. The cut‐off points were estimated by the Youden index. Results The overall procedural success rate was 77.6%. On multivariable analysis, factors including proximal bending (beta coefficient [β] = 3.465), tortuosity (β = 3.064), stent under expansion (β = 3.109) and poor distal landing zone (β = 1.959) were associated with technical failure via antegrade approach but not the J‐CTO score (OR = 0.632; 95% CI [0.352‐1.134]; P = .124). After a median follow‐up of 30 months (interquartile range: 17‐42 months), multivariable analysis revealed that receiving >18 months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of MACE (HR: 2.690; 95% CI: 1.346‐5.347; P = .005). But the J‐CTO score was not an independent predictor of MACE (HR: 1.018; 95% CI: 0.728‐1.424; P = .917). Conclusions J‐CTO score system is not a helpful tool to predict the technical success of difficult IS‐CTO PCI via antegrade approach, nor does it correlate with long‐term outcomes in patients undergoing IS‐CTO PCI. Nevertheless, factors associated with technical failure include proximal bending of ≥30 degrees, under expansion of ≥10 mm, moderate or severe tortuosity (bending) ≥20 and poor distal target. Long‐term DAPT therapy contributes significantly to decreased MACE.