External validation of the PROGRESS‐CTO perforation risk score: Individual patient data pooled analysis of three registries. Issue 2 (8th January 2023)

• Record Type: Journal Article
• Authors: Simsek, Bahadir; Tajti, Peter; Carlino, Mauro; Ojeda, Soledad; Pan, Manuel; Rinfret, Stephane; Vemmou, Evangelia; Kostantinis, Spyridon; Nikolakopoulos, Ilias; Karacsonyi, Judit; Rempakos, Athanasios; Dens, Joseph A.; Agostoni, Pierfrancesco; Alaswad, Khaldoon; Megaly, Michael; Avran, Alexandre; Choi, James W.; Jaffer, Farouc A.; Doshi, Darshan; Karmpaliotis, Dimitri; Khatri, Jaikirshan J.; Knaapen, Paul; La Manna, Alessio; Spratt, James C.; Tanabe, Masaki; Walsh, Simon; Mastrodemos, Olga C.; Allana, Salman; Rangan, Bavana V.; Goktekin, Omer; Gorgulu, Sevket; Poommipanit, Paul; Kearney, Kathleen E.; Lombardi, William L.; Grantham, J. Aaron; Mashayekhi, Kambis; Brilakis, Emmanouil S.; Azzalini, Lorenzo;
• Is Part Of: Catheterization and cardiovascular interventions. Volume 101:Issue 2(2023)
• Page Start: 326
• Page End: 332
• Publication Date: 2023-01-08
• Subjects: chronic total occlusion -- external validation -- major adverse cardiovascular events -- mortality -- percutaneous coronary intervention -- prediction -- risk model; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30551
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Background: Coronary artery perforation is one of the most feared and common complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: To assess the usefulness of the recently developed PROGRESS‐CTO (NCT02061436) perforation risk score in independent cohorts. Individual patient‐level data pooled analysis of three registries was performed. Results: Of the 4566 patients who underwent CTO PCI at 25 centers, 196 (4.2%) had coronary artery perforation. Patients with perforations were older (69 ± 10 vs. 65 ± 10, p < 0.001), more likely to be women (19% vs. 13%, p = 0.009), more likely to have a history of prior coronary artery bypass graft (34% vs. 20%, p < 0.001), and unfavorable angiographic characteristics such as blunt stump (62% vs. 48%, p < 0.001), proximal cap ambiguity (52% vs. 34%, p < 0.001), and moderate‐severe calcification (60% vs. 49%, p = 0.002). Technical success was lower in patients with perforations (73% vs. 88%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS‐CTO perforation risk model was 0.76 (95% confidence interval [CI], 0.72−0.79), with good calibration (Hosmer‐Lemeshow p = 0.97). We found that the CTO PCI perforation risk increased with higher PROGRESS‐CTO perforation scores: 0.3% (score 0), 2.3% (score 1), 3.1% (score 2), 5.5% (score 3), 7.5% (score 4), 14.6% (score 5). Conclusion: Given the good discriminative performance, calibration, and the ease of calculation, the PROGRESS‐CTO perforation score may facilitate assessment of the risk of perforation in patients undergoing CTO PCI.