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. Poommipanit; Bavana V. 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

doi:10.1016/j.jcin.2022.06.007

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 V. 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 journal › Article › peer-review

43 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 language	English (US)
Pages (from-to)	1413-1422
Number of pages	10
Journal	JACC: Cardiovascular Interventions
Volume	15
Issue number	14
DOIs	https://doi.org/10.1016/j.jcin.2022.06.007
State	Published - Jul 25 2022
Externally published	Yes

Keywords

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

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jcin.2022.06.007

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Simsek, B., Kostantinis, S., Karacsonyi, J., Alaswad, K., Krestyaninov, O., Khelimskii, D., Davies, R., Rier, J., Goktekin, O., Gorgulu, S., ElGuindy, A., Chandwaney, R. H., Patel, M., Abi Rafeh, N., Karmpaliotis, D., Masoumi, A., Khatri, J. J., Jaffer, F. A., Doshi, D., ... Brilakis, E. S. (2022). Predicting Periprocedural Complications in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO Complication Scores. JACC: Cardiovascular Interventions, 15(14), 1413-1422. https://doi.org/10.1016/j.jcin.2022.06.007

Simsek, B, Kostantinis, S, Karacsonyi, J, Alaswad, K, Krestyaninov, O, Khelimskii, D, Davies, R, Rier, J, Goktekin, O, Gorgulu, S, ElGuindy, A, Chandwaney, RH, Patel, M, Abi Rafeh, N, Karmpaliotis, D, Masoumi, A, Khatri, JJ, Jaffer, FA, Doshi, D, Poommipanit, PB, Rangan, BV, Sanvodal, Y, Choi, JW, Elbarouni, B, Nicholson, W, Jaber, WA, Rinfret, S, Koutouzis, M, Tsiafoutis, I, Yeh, RW, Burke, MN, Allana, S, Mastrodemos, OC & Brilakis, ES 2022, 'Predicting Periprocedural Complications in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO Complication Scores', JACC: Cardiovascular Interventions, vol. 15, no. 14, pp. 1413-1422. https://doi.org/10.1016/j.jcin.2022.06.007

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

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.",

keywords = "MACE, acute myocardial infarction, chronic total occlusion, mortality, percutaneous coronary intervention, pericardiocentesis, risk prediction",

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

note = "Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = jul,

day = "25",

doi = "10.1016/j.jcin.2022.06.007",

language = "English (US)",

volume = "15",

pages = "1413--1422",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "14",

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TY - JOUR

T1 - Predicting Periprocedural Complications in Chronic Total Occlusion Percutaneous Coronary Intervention

T2 - The PROGRESS-CTO Complication Scores

AU - Simsek, Bahadir

AU - Kostantinis, Spyridon

AU - Karacsonyi, Judit

AU - Alaswad, Khaldoon

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Davies, Rhian

AU - Rier, Jeremy

AU - Goktekin, Omer

AU - Gorgulu, Sevket

AU - ElGuindy, Ahmed

AU - Chandwaney, Raj H.

AU - Patel, Mitul

AU - Abi Rafeh, Nidal

AU - Karmpaliotis, Dimitrios

AU - Masoumi, Amirali

AU - Khatri, Jaikirshan J.

AU - Jaffer, Farouc A.

AU - Doshi, Darshan

AU - Poommipanit, Paul B.

AU - Rangan, Bavana V.

AU - Sanvodal, Yader

AU - Choi, James W.

AU - Elbarouni, Basem

AU - Nicholson, William

AU - Jaber, Wissam A.

AU - Rinfret, Stephane

AU - Koutouzis, Michael

AU - Tsiafoutis, Ioannis

AU - Yeh, Robert W.

AU - Burke, M. Nicholas

AU - Allana, Salman

AU - Mastrodemos, Olga C.

AU - Brilakis, Emmanouil S.

PY - 2022/7/25

Y1 - 2022/7/25

N2 - 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.

AB - 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.

KW - MACE

KW - acute myocardial infarction

KW - chronic total occlusion

KW - mortality

KW - percutaneous coronary intervention

KW - pericardiocentesis

KW - risk prediction

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

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