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Circ Cardiovasc Interv. 2015 Jul;8(7):e002171. doi: 10.1161/CIRCINTERVENTIONS.114.002171.

Clinical Utility of the Japan-Chronic Total Occlusion Score in Coronary Chronic Total Occlusion Interventions: Results from a Multicenter Registry.

Author information

1
From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
2
From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.). esbrilakis@gmail.com.

Abstract

BACKGROUND:

The performance of the Japan-chronic total occlusion (J-CTO) score in predicting success and efficiency of CTO percutaneous coronary intervention has received limited study.

METHODS AND RESULTS:

We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2011 and 2014 at 6 experienced centers in the United States. Six hundred and fifty-seven lesions were classified as easy (J-CTO=0), intermediate (J-CTO=1), difficult (J-CTO=2), and very difficult (J-CTO≥3). The impact of the J-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression, respectively. The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves. Antegrade wiring techniques were used more frequently in easy lesions (97%) than very difficult lesions (58%), whereas the retrograde approach became more frequent with increased lesion difficulty (41% for very difficult lesions versus 13% for easy lesions). The logistic regression model for technical success demonstrated satisfactory calibration and discrimination (P for Hosmer-Lemeshow =0.743 and area under curve =0.705). The J-CTO score was associated with a 2-fold increase in the odds of technical failure (odds ratio 2.04, 95% confidence interval 1.52-2.80, P<0.001). Procedure time increased by ≈20 minutes for every 1-point increase of the J-CTO score (regression coefficient 22.33, 95% confidence interval 17.45-27.22, P<0.001).

CONCLUSIONS:

J-CTO score was strongly associated with final success and efficiency in this study, supporting its expanded use in CTO interventions.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.

KEYWORDS:

J-CTO score; chronic total occlusion; complication; outcome; percutaneous coronary intervention; radiation

[Indexed for MEDLINE]
Free PMC Article

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