Predicting Periprocedural Complications in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO Complication Scores

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Rhian Davies, Jeremy Rier, Omer Goktekin, Sevket Gorgulu, Ahmed ElGuindy, Raj H. Chandwaney, Mitul Patel, Nidal Abi Rafeh, Dimitrios Karmpaliotis, Amirali Masoumi, Jaikirshan J. Khatri, Farouc A. Jaffer, Darshan Doshi, Paul B. PoommipanitBavana Venkata Rangan, Yader Sanvodal, James W. Choi, Basem Elbarouni, William Nicholson, Wissam A. Jaber, Stephane Rinfret, Michael Koutouzis, Ioannis Tsiafoutis, Robert W. Yeh, M. Nicholas Burke, Salman Allana, Olga C. Mastrodemos, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with increased risk of periprocedural complications. Estimating the risk of complications facilitates risk-benefit assessment and procedural planning. Objectives: This study sought to develop risk scores for in-hospital major adverse cardiovascular events (MACE), mortality, pericardiocentesis, and acute myocardial infarction (MI) in patients undergoing CTO PCI. Methods: The study analyzed the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; NCT02061436) and created risk scores for MACE, mortality, pericardiocentesis, and acute MI. Logistic regression prediction modeling was used to identify independently associated variables, and models were internally validated with bootstrapping. Results: The incidence of periprocedural complications among 10,480 CTO PCIs was as follows: MACE 215 (2.05%), mortality 47 (0.45%), pericardiocentesis 83 (1.08%), and acute MI 66 (0.63%). The final model for MACE included ≥65 years of age (1 point), moderate-severe calcification (1 point), blunt stump (1 point), antegrade dissection and re-entry (ADR) (1 point), female (2 points), and retrograde (2 points); the final model for mortality included ≥65 years of age (1 point), left ventricular ejection fraction ≤45% (1 point), moderate-severe calcification (1 point), ADR (1 point), and retrograde (1 point); the final model for pericardiocentesis included ≥65 years of age (1 point), female (1 point), moderate-severe calcification (1 point), ADR (1 point), and retrograde (2 points); the final model for acute MI included prior coronary artery bypass graft surgery (1 point), atrial fibrillation (1 point), and blunt stump (1 point). The C-statistics of the models were 0.74, 0.80, 0.78, 0.72 for MACE, mortality, pericardiocentesis, and acute MI, respectively. Conclusions: The PROGRESS-CTO complication risk scores can facilitate estimation of the periprocedural complication risk in patients undergoing CTO PCI.

Original languageEnglish (US)
Pages (from-to)1413-1422
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume15
Issue number14
DOIs
StatePublished - Jul 25 2022
Externally publishedYes

Keywords

  • acute myocardial infarction
  • chronic total occlusion
  • MACE
  • mortality
  • percutaneous coronary intervention
  • pericardiocentesis
  • risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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