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 PCIHow 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 ≤19Interm SX

19-32 High SX >32

Shiba et al. Int J Cardiol 2014

P=0.03

Is SX score appropriatefor 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 lesionsSuccess

(%)

VariablesPrimary 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 XSuccessful antegrade first

attempt

PROGRESS – CTO

score781 92.9 4 X

Successful hybrid

approach

ORA score1073 91.9 3 X X

Technical failure by both

antegrade and/or

retrograde techniques

Li et al. 728 N/A 3 XContrast 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