Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention

Int J Cardiol. 2016 Dec 1;224:50-56. doi: 10.1016/j.ijcard.2016.08.317. Epub 2016 Aug 23.


Background: Various scoring systems have been developed to predict the technical outcome and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods: We examined the predictive capacity of 3 CTO PCI scores (Clinical and Lesion-related [CL], Multicenter CTO registry in Japan [J-CTO] and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO] scores) in 664 CTO PCIs performed between 2012 and 2016 at 13 US centers.

Results: Technical success was 88% and the retrograde approach was utilized in 41%. Mean CL, J-CTO and PROGRESS CTO scores were 3.9±1.9, 2.6±1.2 and 1.4±1.0, respectively. All scores were inversely associated with technical success (p<0.001 for all) and had moderate discriminatory capacity (area under the curve 0.691 for the CL score, 0.682 for the J-CTO score and 0.647 for the PROGRESS CTO score [p=non-significant for pairwise comparisons]). The difference in technical success between the minimum and maximum CL score strata was the highest (32%, vs. 15% for J-CTO and 18% for PROGRESS CTO scores). All scores tended to perform better in antegrade-only procedures and correlated significantly with procedure time and fluoroscopy dose; the CL score also correlated significantly with contrast utilization.

Conclusions: CL, J-CTO and PROGRESS CTO scores perform moderately in predicting technical outcome of CTO PCI, with better performance for antegrade-only procedures. All scores correlate with procedure time and fluoroscopy dose, and the CL score also correlates with contrast utilization.

Keywords: Chronic total occlusion; Complications; Outcomes; Percutaneous coronary intervention; Procedural success; Techniques.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Coronary Angiography / methods
  • Coronary Angiography / standards*
  • Coronary Occlusion / diagnostic imaging*
  • Coronary Occlusion / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / trends
  • Predictive Value of Tests
  • Prospective Studies
  • Severity of Illness Index*
  • Treatment Outcome