Key result
The PROGRESS CTO complications score, comprising patient age >65 years, lesion length ≥23 mm, and use of the retrograde approach, demonstrated good discriminatory capacity for predicting periprocedural complications with an AUC of 0.793 in the validation cohort.
Observational (n=1,569)
Yes
Effect estimate: AUC 0.793 (95% CI 0.682-0.905)
The PROGRESS CTO complication score is a simple, validated 3-item tool that effectively stratifies the risk of periprocedural complications during CTO PCI.
New CTO PCI complication score may aid risk stratification; leaves open external validation before clinical use.
Background High success rates are achievable for chronic total occlusion ( CTO ) percutaneous coronary intervention ( PCI ) using the hybrid approach, but periprocedural complications remain of concern. Although scores estimating success and efficiency in CTO PCI have been developed, there is currently no available score for estimation of the risk for periprocedural complications. We sought to develop a scoring tool for prediction of periprocedural complications during CTO PCI . Methods and Results We analyzed data from 1569 CTO PCI s in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention ( PROGRESS CTO ) using a derivation and validation sampling ratio of 2:1. Variables independently associated with periprocedural complications in multivariable analysis in the derivation set were assigned points based on their respective odds ratios. Forty‐four (2.8%) patients experienced complications. Three factors were independent predictors of complications and were included in the score: patient age >65 years, +3 points (odds ratio, OR =4.85, CI 1.82‐16.77); lesion length ≥23 mm, +2 points ( OR =3.22, CI 1.08‐13.89); and use of the retrograde approach +1 point ( OR =2.41, CI 1.04‐6.05). The resulting score showed good calibration and discriminatory capacity in the derivation (Hosmer‐Lemeshow χ 2 6.271, P =0.281, receiver‐operating characteristic [ ROC ] area=0.758) and validation (Hosmer‐Lemeshow χ 2 4.551, P =0.473, ROC area=0.793) sets. Score values of 0 to 2, 3 to 4, and ≥5 were defined as low, intermediate, and high risk of complications (derivation cohort 0.4%, 1.8%, 6.5%, P <0.001; validation cohort 0.0%, 2.5%, 6.8%, P <0.001). Conclusions The PROGRESS CTO complication score is a useful tool for prediction of periprocedural complications in CTO PCI . Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02061436.
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Danek et al. (2016) conducted an observational in Chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) (n=1,569). PROGRESS CTO Complications Score (age >65 years, lesion length ≥23 mm, retrograde approach) was evaluated on Discriminatory capacity (AUC) for predicting periprocedural complications in the validation set (AUC 0.793, 95% CI 0.682-0.905). The PROGRESS CTO complications score, comprising patient age >65 years, lesion length ≥23 mm, and use of the retrograde approach, demonstrated good discriminatory capacity for predicting periprocedural complications with an AUC of 0.793 in the validation cohort.
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