Szijgyarto, Zsolt; Rampat, Rajiv; Werner, Gerald S; Ho, Claudius; Reifart, Nicolaus; Lefevre, Thierry; Louvard, Yves; Avran, Alexandre; Kambis, Mashayekhi; Buettner, Heinz-Joachim; +21 more... Di Mario, Carlo; Gershlick, Anthony; Escaned, Javier; Sianos, George; Galassi, Alfredo; Garbo, Roberto; Goktekin, Omer; Meyer-Gessner, Marcus; Lauer, Bernward; Elhadad, Simon; Bufe, Alexander; Boudou, Nicolas; Sievert, Horst; Martin-Yuste, Victoria; Thuesen, Leif; Erglis, Andrejs; Christiansen, Evald; Spratt, James; Bryniarski, Lesciak; Clayton, Tim; Hildick-Smith, David; (2019) Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score. JACC: Cardiovascular Interventions, 12 (4). pp. 335-342. ISSN 1876-7605 DOI: https://doi.org/10.1016/j.jcin.2018.11.020
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
Abstract
OBJECTIVES: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. BACKGROUND: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. METHODS: The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. RESULTS: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. CONCLUSIONS: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.
Item Type | Article |
---|---|
Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Medical Statistics |
Research Centre | Clinical Trials Unit |
PubMed ID | 30711551 |
Official URL | https://www.sciencedirect.com/science/article/pii/... |
Downloads
Filename: Manuscript v4 clean.pdf
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 3.0
DownloadFilename: Tables.pdf
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 3.0
DownloadFilename: Supplementary tables.pdf
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 3.0
DownloadFilename: figure1.zip
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 3.0
Download