Key result
The E-CTO score, which incorporates operator experience and anatomical variables, adequately predicted the probability of CTO-PCI failure with an AUC of 0.704 in the validation cohort.
Why the study?
Operator experience is a decisive factor for achieving successful CTO-PCI results, but its impact has not been previously incorporated into scoring systems predicting procedural success.
Does the E-CTO score, which incorporates both anatomic variables and operator experience, accurately predict procedural failure in patients undergoing CTO-PCI?
Cohort (n=457)
No
Does the E-CTO score, which incorporates both anatomic variables and operator experience, accurately predict procedural failure in patients undergoing CTO-PCI?
Effect estimate: AUC 0.704 (95% CI 0.613-0.796)
p-value: p=<0.001
The E-CTO score highlights the critical impact of operator experience on CTO-PCI outcomes and successfully combines it with anatomical factors to predict procedural success.
May aid CTO-PCI risk stratification by including experience; extends anatomy-only scores but leaves open prospective validation and impact.
BACKGROUND: Several scoring systems have been developed in order to predict percutaneous coronary intervention (PCI) result of chronic total occlusion (CTO). The scores principally include anatomic and clinical variables. Operator experience is a decisive factor for achieving successful result. We sought to assess the real impact of operator growing experience on CTO-PCI success. METHODS: The angiographic and clinical variables of CTO-PCIs performed in our center between May 2007 and April 2021 were collected, and variables with potential association with procedural result were thoroughly reviewed. The influence of operator experience based on the number of previous CTO-PCIs was statistically assessed. A scoring system with combination of anatomic variables and operator experience was devised. RESULTS: A total of 540 PCIs in 457 patients were performed in our institution. The scoring model was developed from the derivation set (2/3 of the cohort). The final variables in logistic regression model were CTO length ≥ 20 mm, blunt stump, vessel tortuosity > 45o and operator experience < 100 PCIs. The model showed good performance in the derivation set (area under curve [AUC]: 0.768; confidence interval [CI]: 0706-0.830; p < 0.001) with no significant shrinkage in the validation set (AUC: 0.704; CI: 0.613-0.796; p < 0.001). CONCLUSIONS: This new score (E-CTO score) adequately predict the probability of CTO-PCI failure. The model includes a variable representing operator experience along with other anatomic variables.
No takes yet. Share an insight, caveat, or question.
Mohandes et al. (2021) conducted a cohort in Chronic total occlusion (CTO) (n=457). E-CTO score (anatomic variables and operator experience < 100 PCIs) was evaluated on Probability of CTO-PCI failure (evaluated in validation set) (AUC 0.704, 95% CI 0.613-0.796, p=<0.001). The E-CTO score, which incorporates operator experience and anatomical variables, adequately predicted the probability of CTO-PCI failure with an AUC of 0.704 in the validation cohort.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: