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
Author Information
Bahadir Simsek: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Spyridon Kostantinis: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Judit Karacsonyi: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Khaldoon Alaswad: Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
Oleg Krestyaninov: Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
Dmitrii Khelimskii: Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
Rhian Davies: Division of Cardiology, WellSpan York Hospital, York, Pennsylvania, USA.
Jeremy Rier: Division of Cardiology, WellSpan York Hospital, York, Pennsylvania, USA.
Omer Goktekin: Division of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey.
Sevket Gorgulu: Division of Cardiology, Acibadem Kocaeli Hospital, Izmit, Turkey.
Ahmed ElGuindy: Division of Cardiology, Aswan Heart Center, Aswan, Egypt.
Raj H Chandwaney: Division of Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma, USA.
Mitul Patel: Division of Cardiology, University of California San Diego, San Diego, California, USA.
Nidal Abi Rafeh: Division of Cardiology, North Oaks Health System, Hammond, Louisiana, USA.
Dimitrios Karmpaliotis: Gagnon Cardiovascular Institute, Morristown Medical Center, New Jersey, USA.
Amirali Masoumi: Gagnon Cardiovascular Institute, Morristown Medical Center, New Jersey, USA.
Jaikirshan J Khatri: Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Farouc A Jaffer: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Darshan Doshi: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Paul B Poommipanit: Division of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
Bavana V Rangan: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Yader Sanvodal: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
James W Choi: Cardiology Division, Baylor Heart and Vascular Institute, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
Basem Elbarouni: Section of Cardiology, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
William Nicholson: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Wissam A Jaber: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Stephane Rinfret: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Michael Koutouzis: Second Cardiology Department, Red Cross General Hospital, Athens, Greece.
Ioannis Tsiafoutis: Second Cardiology Department, Red Cross General Hospital, Athens, Greece.
Robert W Yeh: Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
M Nicholas Burke: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Salman Allana: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Olga C Mastrodemos: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Emmanouil S Brilakis: Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA. Electronic address: esbrilakis@gmail.com.
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.
