Technological advancements and technique improvements have significantly enhanced the success rate of percutaneous interventions for treating chronic total occlusions (CTO). Angiographic scores and CTO-PCI algorithms are valuable tools that help us select the optimal strategy when planning these procedures. The retrograde strategy, specifically, has proven beneficial in addressing complex CTOs. However, standardized tools to predict the success of this strategy have not yet been established.
Therefore, the aim of this prospective non-randomized study was to develop a prediction tool that identifies CTO lesions that can be successfully treated via retrograde CTO-PCI.
The study included 2374 patients who underwent primary retrograde CTO-PCI and were registered in the Japanese CTO-PCI Expert Registry between January 2016 and December 2022. Observations were randomized to derivation and validation cohorts in a 2:1 ratio.
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The JR-CTO score, which considers moderate-severe calcification, tortuosity, Werner collateral connection grade ≤1, and non-septal collateral channel, showed predictive capacity (C-statistic) for guidewire failure around 0.72 (95% confidence interval [CI]: 0.67-0.76) and 0.71 (95% CI: 0.64-0.77) in the derivation and validation cohorts, respectively. Patients with lower scores had higher rates of technical and guidewire success, as well as a reduction in both guidewire crossing time and procedure time (P <0.01).
Conclusion
The JR-CTO score, composed of four items, effectively predicts successful guidewire crossing in patients undergoing retrograde CTO-PCI. Patients with lower scores on this scale have higher rates of technical and guidewire success, and decreased procedure time and guidewire crossing time.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Retrograde Coronary Chronic Total Occlusion Intervention (JR-CTO) Score From the Japanese CTO-PCI Expert Registry.
Reference: Hiroyuki Tanaka, MD et al J Am Coll Cardiol Intv 2024.
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