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Catheter Cardiovasc Interv. 2018 Feb 1;91(2):192-202. doi: 10.1002/ccd.27092. Epub 2017 May 4.

Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score.

Author information

1
Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.
2
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
3
Department of Cardiology, Forth Valley Royal Hospital, Edinburgh, United Kingdom.
4
Department of Cardiology, VU university medical center, Amsterdam, the Netherlands.
5
Department of Cardiology, Belfast City Hospital, Belfast, United Kingdom.
6
Department of Cardiology, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands.
7
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
8
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
9
Department of Cardiology, Clinique de Marignane, Marignane, Marseille, France.
10
Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France.
11
Department of Cardiology, Nouvelles Cliniques Nantaises, Nantes, France.
12
Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
13
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
14
Institute of Cellular Medicine, Newcastle University, United Kingdom.
15
Department of Cardiology, Morriston Hospital, Swansea, United Kingdom.
16
Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom.
17
Department of Cardiology, Nottingham University Hospital, Nottingham, United Kingdom.
18
Department of Cardiology, Essex Cardio-thoracic Centre, Basildon Hospital, Essex, United Kingdom.
19
Department of Cardiology, Ninewells Hospital, Dundee, United Kingdom.
20
Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
21
Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom.

Abstract

OBJECTIVES:

This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels.

BACKGROUND:

Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators.

METHODS:

Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores.

RESULTS:

Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores.

CONCLUSIONS:

The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators. © 2017 Wiley Periodicals, Inc.

KEYWORDS:

atherosclerosis; chronic total occlusion; coronary artery disease; percutaneous coronary intervention

PMID:
28471074
DOI:
10.1002/ccd.27092
[Indexed for MEDLINE]

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