6533b857fe1ef96bd12b40d7
RESEARCH PRODUCT
Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry : the EuroCTO (CASTLE) Score
Zsolt SzijgyartoRajiv RampatGerald S WernerClaudius HoNicolaus ReifartThierry LefevreYves LouvardAlexandre AvranMashayekhi KambisHeinz-joachim BuettnerCarlo Di MarioAnthony GershlickJavier EscanedGeorge SianosAlfredo GalassiRoberto GarboOmer GoktekinMarcus Meyer-gessnerBernward LauerSimon ElhadadAlexander BufeNicolas BoudouHorst SievertVictoria Martin-yusteLeif ThuesenAndrejs ErglisEvald ChristiansenJames SprattLesciak BryniarskiTim ClaytonDavid Hildick-smithsubject
Aged 80 and overMaleDatabases FactualRisk Factorpercutaneous coronary interventionscoring systemReproducibility of Resultschronic total occlusion; coronary artery disease; percutaneous coronary intervention; scoring system; Aged; Aged 80 and over; Chronic Disease; Coronary Occlusion; Databases Factual; Europe; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Predictive Value of Tests; Registries; Reproducibility of Results; Risk Assessment; Risk Factors; Treatment Failure; Decision Support TechniquesMiddle AgedRisk AssessmentDecision Support TechniquesEuropePercutaneous Coronary InterventionCoronary OcclusionPredictive Value of TestsRisk FactorsChronic DiseaseHumansFemaleRegistriesTreatment Failurechronic total occlusioncoronary artery diseaseAgeddescription
Objectives: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. Background: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. Methods: The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. Results: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. Conclusions: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-02-25 |