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28-29 March 2014
Marouane Boukhris MD, FESC
Department of Clinical and Experimental Medicine
University of Catania, Italy
Faculty of Medicine of Tunis, University of Tunis El Manar,
Tunisia
Scores in CTO PCI
How Do They Help?
 CTO PCI are considered be more costly and complex procedures
 CTO PCI might be associated with lower success rate and higher
incidence of peri-procedural complications
 CTO patients successfully revascularized showed better CV outcome
than those in whom CTO attempt failed
 Selection of appropriate PCI candidates among CTO patients = key
issue to ensure success and good outcome
Introduction
Importance of predictive scores in CTO PCI
Predictive scores for CTO PCI
Non Specific Specific
Non Specific Scores
Nagashima et al. Herz 2015
Technical Failure 30-day MACE
0
20
40
60
80
100
Low SX ≤19
Interm SX
19-32 High SX >32
Shiba et al. Int J Cardiol 2014
P=0.03
Is SX score appropriate
for CTO PCI ?
Inappropriateness of SX score
for CTO PCI
Specific Scores for CTO PCI
J-CTO score
Morino et al. JACC interv 2011
RECALL
J-CTO score
Christopoulos et al. Circ Cardiovasc Interv 2015
J-CTO score
AUC=0.556
Galassi et al. JACC interv 2016
CL-RECTOR Score
Opolski et al. JACC interv 2015
CL Score
Alessandrino et al. JACC interv 2015
Variable Score
Severe calcified lesion 2
Previous CABG 1.5
Lesion length ≥20 mm 1.5
Previous MI 1
Blunt stump 1
Non-LAD CTO location 1
suitable for centers where the
retrograde or hybrid approach has not
yet been implemented
First Antegrade Attempt
PROGRESS CTO Score
Hybrid Approach
Christopoulos et al. JACC interv 2016
ORA Score
Ora et labora
(if <3)
Both antegrade & retrograde techniques
Galassi et al. JACC interv JACC 2016
Variable Score
Age ≥75 years 1
LVEF <40% 1
S Cr > 1.5mg/dL 2
Li et al. Intern J Cardiol 2015
Karatasakis et al. Int J Cardiol 2016
Karatasakis et al. Int J Cardiol 2016
Specific CTO scores
Boukhris et al. J Thorac Dis 2016
Specific CTO Score N CTO lesions
Success
(%)
Variables
Primary endpoint
N Clinical Angiographic CCTA
J- CTO score 494 88.6 5 X X GW crossing within 30 min
CT –RECTOR score 240 65 6 X X GW crossing within 30 min
CL score 1657 72.5 6 X X
Successful antegrade first
attempt
PROGRESS – CTO
score
781 92.9 4 X
Successful hybrid
approach
ORA score
1073 91.9 3 X X
Technical failure by both
antegrade and/or
retrograde techniques
Li et al. 728 N/A 3 X
Contrast induced
nephropathy
Specific CTO scores
Take Home Messages
 Specific predictive models for CTO PCI are very useful tools to estimate
the likelihood of guidewire crossing, the probability of procedural
success and even CV outcome
The most difficult challenge is to clarify the multiple information given
from different scores and to draw the right conclusions
 Predictive scores could be applied to select the appropriate candidates
for PCI among CTO patients and the appropriate strategy to use
Accurate pre-procedural assessment of how challenging a lesion is
could help in procedural planning, to estimate the duration of the
procedure and/or the need to refer the patient to another center with
expertise in CTO PCI
Marouane Boukhris - Scores in CTO PCI How Do They Help?

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Marouane Boukhris - Scores in CTO PCI How Do They Help?

  • 1. 28-29 March 2014 Marouane Boukhris MD, FESC Department of Clinical and Experimental Medicine University of Catania, Italy Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia Scores in CTO PCI How Do They Help?
  • 2.  CTO PCI are considered be more costly and complex procedures  CTO PCI might be associated with lower success rate and higher incidence of peri-procedural complications  CTO patients successfully revascularized showed better CV outcome than those in whom CTO attempt failed  Selection of appropriate PCI candidates among CTO patients = key issue to ensure success and good outcome Introduction Importance of predictive scores in CTO PCI
  • 3. Predictive scores for CTO PCI Non Specific Specific
  • 5. Nagashima et al. Herz 2015 Technical Failure 30-day MACE
  • 6. 0 20 40 60 80 100 Low SX ≤19 Interm SX 19-32 High SX >32 Shiba et al. Int J Cardiol 2014 P=0.03
  • 7. Is SX score appropriate for CTO PCI ?
  • 8. Inappropriateness of SX score for CTO PCI
  • 10. J-CTO score Morino et al. JACC interv 2011 RECALL
  • 11. J-CTO score Christopoulos et al. Circ Cardiovasc Interv 2015
  • 12. J-CTO score AUC=0.556 Galassi et al. JACC interv 2016
  • 13. CL-RECTOR Score Opolski et al. JACC interv 2015
  • 14. CL Score Alessandrino et al. JACC interv 2015 Variable Score Severe calcified lesion 2 Previous CABG 1.5 Lesion length ≥20 mm 1.5 Previous MI 1 Blunt stump 1 Non-LAD CTO location 1 suitable for centers where the retrograde or hybrid approach has not yet been implemented First Antegrade Attempt
  • 15. PROGRESS CTO Score Hybrid Approach Christopoulos et al. JACC interv 2016
  • 16. ORA Score Ora et labora (if <3) Both antegrade & retrograde techniques Galassi et al. JACC interv JACC 2016
  • 17. Variable Score Age ≥75 years 1 LVEF <40% 1 S Cr > 1.5mg/dL 2 Li et al. Intern J Cardiol 2015
  • 18. Karatasakis et al. Int J Cardiol 2016
  • 19. Karatasakis et al. Int J Cardiol 2016
  • 20. Specific CTO scores Boukhris et al. J Thorac Dis 2016
  • 21. Specific CTO Score N CTO lesions Success (%) Variables Primary endpoint N Clinical Angiographic CCTA J- CTO score 494 88.6 5 X X GW crossing within 30 min CT –RECTOR score 240 65 6 X X GW crossing within 30 min CL score 1657 72.5 6 X X Successful antegrade first attempt PROGRESS – CTO score 781 92.9 4 X Successful hybrid approach ORA score 1073 91.9 3 X X Technical failure by both antegrade and/or retrograde techniques Li et al. 728 N/A 3 X Contrast induced nephropathy Specific CTO scores
  • 22. Take Home Messages  Specific predictive models for CTO PCI are very useful tools to estimate the likelihood of guidewire crossing, the probability of procedural success and even CV outcome The most difficult challenge is to clarify the multiple information given from different scores and to draw the right conclusions  Predictive scores could be applied to select the appropriate candidates for PCI among CTO patients and the appropriate strategy to use Accurate pre-procedural assessment of how challenging a lesion is could help in procedural planning, to estimate the duration of the procedure and/or the need to refer the patient to another center with expertise in CTO PCI