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.
Por:
Salinas P, Gonzalo N, Moreno V, Fuentes M, Santos-Martinez S, Fernandez-Diaz J, Amat-Santos I, Ojeda F, Borrego J, Cuesta J, Hernandez J, Diego-Nieto A, Dubois D, Galeote G, Goicolea J, Gutierrez A, Jimenez-Fernandez M, Jimenez-Mazuecos J, Jurado A, Lacunza J, Lee D, Lopez M, Lozano F, Martin-Moreiras J, Martin-Yuste V, Millan R, Minana G, Mohandes M, Morales-Ponce F, Nunez J, Ojeda S, Pan M, Rivero F, Robles J, Rodriguez-Leiras S, Rojas S, Rondan J, Rumiz E, Sabate M, Sanchis J, Vaquerizo B, Escaned J
Publicada:
2 abr 2021
Ahead of Print:
2 abr 2021
Resumen:
BACKGROUND: We 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. METHODS: Scores 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. RESULTS: Mean 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, p<0.001), similar to J-CTO and slightly inferior to CL score (- 0.011, p = 0.004). Regarding net reclassification improvement, CASTLE reclassified better than PROGRESS (overall continuous net reclassification improvement 0.379, p<0.001) in roughly 20% of cases. CONCLUSION: Procedural 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.
Filiaciones:
Salinas P:
Hosp Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Cardiol Dept, Madrid, Spain
Gonzalo N:
Hosp Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Cardiol Dept, Madrid, Spain
Moreno V:
Hosp Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Cardiol Dept, Madrid, Spain
Fuentes M:
Hosp Clin San Carlos, Inst Invest Sanitaria San Carlos IdISSC, Serv Med Prevent, Madrid, Spain
Santos-Martinez S:
Hosp Clin Univ Valladolid, Inst Ciencias Corazon ICICOR, Valladolid, Spain
Fernandez-Diaz J:
Hosp Univ Puerta de Hierro, Intervent Cardiol Dept, Majadahonda, Spain
Amat-Santos I:
Hosp Clin Univ Valladolid, Inst Ciencias Corazon ICICOR, Valladolid, Spain
Ojeda F:
Hosp Tenerife, Serv Cardiol, Tenerife, Spain
Borrego J:
HU San Cecilio, Serv Cardiol, Granada, Spain
Cuesta J:
Hosp Princesa, Serv Cardiol, Madrid, Spain
Hernandez J:
Hosp Valdecilla, Serv Cardiol, Santander, Spain
Diego-Nieto A:
Complejo Asistencial Univ Salamanca, Serv Cardiol, CIBERCV, IBSAL, Salamanca, Spain
Dubois D:
Hosp del Mar, Serv Cardiol, Barcelona, Spain
Galeote G:
Hosp La Paz, Serv Cardiol, Madrid, Spain
Goicolea J:
Hosp Univ Puerta de Hierro, Intervent Cardiol Dept, Majadahonda, Spain
Gutierrez A:
Hosp Jerez, Serv Cardiol, Jerez de la Frontera, Spain
Jimenez-Fernandez M:
HU San Cecilio, Serv Cardiol, Granada, Spain
HU Virgen Nieves, Serv Cardiol, Granada, Spain
Jimenez-Mazuecos J:
Hosp Albacete, Serv Cardiol, Albacete, Spain
Jurado A:
Hosp La Paz, Serv Cardiol, Madrid, Spain
Hosp Ciudad Real, Serv Cardiol, Ciudad Real, Spain
Lacunza J:
Hosp Arrixaca, Serv Cardiol, Murcia, Spain
Lee D:
Hosp Valdecilla, Serv Cardiol, Santander, Spain
Lopez M:
Hosp Leon, Serv Cardiol, Leon, Spain
Lozano F:
Hosp Ciudad Real, Serv Cardiol, Ciudad Real, Spain
Martin-Moreiras J:
Complejo Asistencial Univ Salamanca, Serv Cardiol, CIBERCV, IBSAL, Salamanca, Spain
Martin-Yuste V:
Hosp Clin Barcelona, Inst Cardiovasc, Serv Cardiol, CIBER CV,IDIBAPS, Barcelona, Spain
Millan R:
Hosp del Mar, Serv Cardiol, Barcelona, Spain
Minana G:
Univ Valencia, Serv Cardiol, CIBERCV, Hosp Clin Valencia, Valencia, Spain
Mohandes M:
Hosp Joan 23, Serv Cardiol, Tarragona, Spain
Morales-Ponce F:
Hosp Puerto Real, Serv Cardiol, Puerto Real, Spain
Nunez J:
Univ Valencia, Serv Cardiol, CIBERCV, Hosp Clin Valencia, Valencia, Spain
Ojeda S:
Univ Cordoba, Reina Sofia Hosp, Maimonides Inst Res Biomed Cordoba IMIBIC, Cordoba, Spain
Pan M:
Univ Cordoba, Reina Sofia Hosp, Maimonides Inst Res Biomed Cordoba IMIBIC, Cordoba, Spain
Rivero F:
Hosp Princesa, Serv Cardiol, Madrid, Spain
Robles J:
Hosp Burgos, Serv Cardiol, Burgos, Spain
Rodriguez-Leiras S:
Hosp Virgen Macarena, Serv Cardiol, Malaga, Spain
Rojas S:
Hosp Joan 23, Serv Cardiol, Tarragona, Spain
Rondan J:
Hosp Cabuenes, Serv Cardiol, Gijon, Spain
Rumiz E:
Hosp Gen Valencia, Serv Cardiol, Valencia, Spain
Sabate M:
Hosp Clin Barcelona, Inst Cardiovasc, Serv Cardiol, CIBER CV,IDIBAPS, Barcelona, Spain
Sanchis J:
Univ Valencia, Serv Cardiol, CIBERCV, Hosp Clin Valencia, Valencia, Spain
Vaquerizo B:
Hosp del Mar, Serv Cardiol, Barcelona, Spain
Escaned J:
Hosp Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Cardiol Dept, Madrid, Spain
gold, Green Published
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