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Angiographic Scoring System for Predicting Successful Percutaneous Coronary Intervention of In-Stent Chronic Total Occlusion

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Abstract

The purpose of this study was to develop a scoring model to predict the technical success of recanalizing via antegrade approach in-stent chronic total occlusion (IS-CTO) by percutaneous coronary intervention (PCI). We retrospectively collected data from 474 patients who underwent an uneasy IS-CTO PCI via antegrade approach from January 2015 to December 2018, consecutively. We selected clinical and angiographic factors and utilized a derivation and validation cohort (4:1 sampling ratio) analysis. Factors with strong correlations with technical failure, according to multivariable analysis, were assigned 1 point, and a scoring system with a 4-point maximum was established. The model was then validated with a validation cohort. The overall procedural success rate was 77.4%. On multivariable analysis, the factors that correlated with technical failure were proximal bending (beta coefficient [β] = 2.142), tortuosity (β = 2.622), stent under expansion (β = 3.052), and poor distal landing zone (β = 2.004). The IS-CTO score demonstrated good calibration and excellent predicting capacity in the derivation (receiver-operator characteristic [ROC] area = 0.973 and Hosmer-Lemeshow chi-squared = 5.252; p = 0.072) and validation (ROC area = 0.976 and Hosmer-Lemeshow chi-squared = 0.916; p = 0.632) cohorts. In the validation subset, the IS-CTO score demonstrated superior performance to the Japanese chronic total occlusion score (J-CTO) and PROGRESS CTO scores for predicting technical success (area under the a curve [AUC] 0.976 vs. 0.642 vs. 0.579, respectively; difference in AUC between the IS-CTO score and J-CTO score = 0.334, p < 0.01; difference in AUC between the IS-CTO score and PROGRESS score = 0.397, p < 0.01). Our results suggest that the IS-CTO score system is a helpful tool to predict the technical success of IS-CTO PCI via antegrade approach in china.

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Abbreviations

AUC:

area under the curve

ROC:

receiver-operator characteristic

CABG:

coronary artery bypass graft surgery

MI:

myocardial infarction

CTO:

chronic total occlusion

IS-CTO:

in-stent chronic total occlusion

PCI:

percutaneous coronary intervention

TIMI:

thrombolysis in myocardial infarction

LAD:

left anterior descending coronary artery

LCX:

left circumflex

RCA:

right coronary artery

J-CTO:

Japanese chronic total occlusion score

IVUS:

intravascular ultrasound

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Acknowledgments

The authors thank the voluntary contribution of the patients in this study.

Author information

Authors and Affiliations

  1. Department of Cardiology, Dalian The Fifth People’s Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China

    Minglian Gong, Jing Zhang, Mingrui Lv & Xin Li

  2. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China

    Minglian Gong, Hongyu Peng, Zheng Wu, Wenzheng Li, Yun Lv, Yuan Lv, Ze Zheng & Jinghua Liu

  3. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, National Center for Cardiovascular Disease, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China

    Tao An & Yi Mao

  4. Department of Cardiology, Dalian The Sixth People’s Hospital, No.269 Luganghuibo Road, Ganjingzi District, Dalian, 116033, Liaoning, China

    Hangyu Gong

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  1. Minglian Gong
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Contributions

Study conception and design: YM and J-HL. Acquisition of data: M-LG, W-ZL, YL, YUL, M-RL, XL, JZ, Y-HG, TA, and XL. Analysis and interpretation of data (e.g., statistical and computational analysis): M-LG, TA, H-YP, ZW, YM, J-HL, and ZZ. Writing, review, and/or revision of the manuscript: M-LG, YM, and J-HL. Study supervision: YM and J-HL.

Corresponding authors

Correspondence to Yi Mao or Jinghua Liu.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This investigation was approved by the institutional review boards of the two centers and was conducted in line with the principles of the Helsinki declaration. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all participants included in the study.

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Associate Editor Angela Taylor oversaw the review of this article.

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Gong, M., Peng, H., Wu, Z. et al. Angiographic Scoring System for Predicting Successful Percutaneous Coronary Intervention of In-Stent Chronic Total Occlusion. J. of Cardiovasc. Trans. Res. 14, 598–609 (2021). https://doi.org/10.1007/s12265-020-10090-9

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