PLoS ONE (Jan 2021)

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators.

  • Pablo Salinas,
  • Nieves Gonzalo,
  • Víctor H Moreno,
  • Manuel Fuentes,
  • Sandra Santos-Martinez,
  • José Antonio Fernandez-Diaz,
  • Ignacio J Amat-Santos,
  • Francisco Bosa Ojeda,
  • Juan Caballero Borrego,
  • Javier Cuesta,
  • José María de la Torre Hernández,
  • Alejandro Diego-Nieto,
  • Daniela Dubois,
  • Guillermo Galeote,
  • Javier Goicolea,
  • Alejandro Gutiérrez,
  • Miriam Jiménez-Fernández,
  • Jesús Jiménez-Mazuecos,
  • Alfonso Jurado,
  • Javier Lacunza,
  • Dae-Hyun Lee,
  • María López,
  • Fernando Lozano,
  • Javier Martin-Moreiras,
  • Victoria Martin-Yuste,
  • Raúl Millán,
  • Gema Miñana,
  • Mohsen Mohandes,
  • Francisco J Morales-Ponce,
  • Julio Núñez,
  • Soledad Ojeda,
  • Manuel Pan,
  • Fernando Rivero,
  • Javier Robles,
  • Sergio Rodríguez-Leiras,
  • Sergio Rojas,
  • Juan Rondán,
  • Eva Rumiz,
  • Manel Sabaté,
  • Juan Sanchís,
  • Beatriz Vaquerizo,
  • Javier Escaned

DOI
https://doi.org/10.1371/journal.pone.0245898
Journal volume & issue
Vol. 16, no. 4
p. e0245898

Abstract

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BackgroundWe aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.MethodsScores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.ResultsMean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, pConclusionProcedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.