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Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

View Article: PubMed Central - PubMed

ABSTRACT

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 PCIs 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 χ2 6.271, P=0.281, receiver‐operating characteristic [ROC] area=0.758) and validation (Hosmer‐Lemeshow χ2 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: NCT02061436.

No MeSH data available.


Related in: MedlinePlus

Comparison of the PROGRESS CTO complications score with other scoring systems. The PROGRESS CTO complications score is compared with the J‐CTO score, the PROGRESS CTO score, and the CL score in the validation set. The areas under the curves (AUCs) were PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were as follows: J‐CTO score Δ=0.117, P=0.15; PROGRESS CTO score Δ=0.292, P<0.001; and CL score Δ=0.017, P=0.83. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
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jah31825-fig-0005: Comparison of the PROGRESS CTO complications score with other scoring systems. The PROGRESS CTO complications score is compared with the J‐CTO score, the PROGRESS CTO score, and the CL score in the validation set. The areas under the curves (AUCs) were PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were as follows: J‐CTO score Δ=0.117, P=0.15; PROGRESS CTO score Δ=0.292, P<0.001; and CL score Δ=0.017, P=0.83. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.

Mentions: The performance of the PROGRESS CTO complications score for predicting occurrence of periprocedural MACE was compared with those of other CTO PCI scores. The J‐CTO score, the PROGRESS CTO score, and the CL score were compared with the PROGRESS CTO complications score for prediction of complications in the validation set (Figure 5). The AUCs were: PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were J‐CTO score Δ=0.117 (P=0.15); PROGRESS CTO score Δ=0.292 (P<0.001); and CL score Δ=0.017 (P=0.83).


Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score
Comparison of the PROGRESS CTO complications score with other scoring systems. The PROGRESS CTO complications score is compared with the J‐CTO score, the PROGRESS CTO score, and the CL score in the validation set. The areas under the curves (AUCs) were PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were as follows: J‐CTO score Δ=0.117, P=0.15; PROGRESS CTO score Δ=0.292, P<0.001; and CL score Δ=0.017, P=0.83. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5121521&req=5

jah31825-fig-0005: Comparison of the PROGRESS CTO complications score with other scoring systems. The PROGRESS CTO complications score is compared with the J‐CTO score, the PROGRESS CTO score, and the CL score in the validation set. The areas under the curves (AUCs) were PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were as follows: J‐CTO score Δ=0.117, P=0.15; PROGRESS CTO score Δ=0.292, P<0.001; and CL score Δ=0.017, P=0.83. PROGRESS CTO indicates Prospective Global Registry for the Study of Chronic Total Occlusion Intervention.
Mentions: The performance of the PROGRESS CTO complications score for predicting occurrence of periprocedural MACE was compared with those of other CTO PCI scores. The J‐CTO score, the PROGRESS CTO score, and the CL score were compared with the PROGRESS CTO complications score for prediction of complications in the validation set (Figure 5). The AUCs were: PROGRESS CTO complications score 0.793 (95% CI 0.682‐0.905), J‐CTO score 0.676 (95% CI 0.560‐0.791), PROGRESS CTO score 0.501 (95% CI 0.379‐0.620), and CL score 0.776 (95% CI 0.669‐0.884), respectively. The differences in AUCs between the PROGRESS CTO complications score and other scores were J‐CTO score Δ=0.117 (P=0.15); PROGRESS CTO score Δ=0.292 (P<0.001); and CL score Δ=0.017 (P=0.83).

View Article: PubMed Central - PubMed

ABSTRACT

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 PCIs 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&#8208;four (2.8%) patients experienced complications. Three factors were independent predictors of complications and were included in the score: patient age &gt;65&nbsp;years, +3 points (odds ratio, OR=4.85, CI 1.82&#8208;16.77); lesion length &ge;23&nbsp;mm, +2 points (OR=3.22, CI 1.08&#8208;13.89); and use of the retrograde approach +1 point (OR=2.41, CI 1.04&#8208;6.05). The resulting score showed good calibration and discriminatory capacity in the derivation (Hosmer&#8208;Lemeshow &chi;2 6.271, P=0.281, receiver&#8208;operating characteristic [ROC] area=0.758) and validation (Hosmer&#8208;Lemeshow &chi;2 4.551, P=0.473, ROC area=0.793) sets. Score values of 0 to 2, 3 to 4, and &ge;5 were defined as low, intermediate, and high risk of complications (derivation cohort 0.4%, 1.8%, 6.5%, P&lt;0.001; validation cohort 0.0%, 2.5%, 6.8%, P&lt;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: NCT02061436.

No MeSH data available.


Related in: MedlinePlus