External validation of the PROGRESS-CTO complication risk scores: Individual patient data pooled analysis of 3 registries.
Bahadir Simsek, Peter Tajti, Mauro Carlino, Soledad Ojeda, Manuel Pan, Stephane Rinfret, Evangelia Vemmou, Spyridon Kostantinis, Ilias Nikolakopoulos, Judit Karacsonyi, Joseph A Dens, Pierfrancesco Agostoni, Khaldoon Alaswad, Michael Megaly, Alexandre Avran, James W Choi, Farouc A Jaffer, Darshan Doshi, Dimitri Karmpaliotis, Jaikirshan J Khatri, Paul Knaapen, Alessio La Manna, James C Spratt, Masaki Tanabe, Simon Walsh, Olga C Mastrodemos, Salman Allana, Athanasios Rempakos, Bavana V Rangan, Omer Goktekin, Sevket Gorgulu, Paul Poommipanit, Kathleen E Kearney, William L Lombardi, J Aaron Grantham, Kambis Mashayekhi, Emmanouil S Brilakis, Lorenzo Azzalini
Author Information
Bahadir Simsek: Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Peter Tajti: The Gottsegen National Cardiovascular Center, Budapest, Hungary.
Mauro Carlino: Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
Soledad Ojeda: Division of Interventional Cardiology, Reina Sofia Hospital, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Cordoba, Spain.
Manuel Pan: Division of Interventional Cardiology, Reina Sofia Hospital, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Cordoba, Spain.
Stephane Rinfret: Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, GA, USA.
Evangelia Vemmou: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Spyridon Kostantinis: Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Ilias Nikolakopoulos: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Judit Karacsonyi: Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Joseph A Dens: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with a considerable risk of complications, and risk stratification is of utmost importance. AIMS: To assess the clinical usefulness of the recently developed PROGRESS-CTO (NCT02061436) complication risk scores in an independent cohort. METHODS: Individual patient data pooled analysis of 3 registries was performed. RESULTS: Of the 4569 patients who underwent CTO PCI, 102 (2.2%) had major adverse cardiovascular events (MACE). patients with MACE were older (69 ± 11 vs. 65 ± 10, p < 0.001), more likely to have a history of prior coronary artery bypass graft surgery, and unfavorable angiographic characteristics J-CTO score (2.4 ± 1.2 vs. 2.1 ± 1.3, p = 0.007), including blunt stump (59% vs. 49%, p = 0.047). Technical success was lower in patients with MACE (59% vs. 86%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO complication risk models were as follows: MACE 0.72 (95% confidence interval [CI], 0.67-0.76), mortality 0.73 (95% CI, 0.61-0.85), and pericardiocentesis 0.69 (95% CI, 0.62-0.77) in the validation dataset. The observed complication rates increased with higher PROGRESS-CTO complication scores. The PROGRESS-CTO MACE score showed good calibration in this external cohort, with MACE rates similar to the original study: 0.7% (score 0-1), 1.5% (score 2), 2.2% (score 3), 3.8% (score 4), 4.9% (score 5), 5.8% (score 6-7). CONCLUSION: Given the good discriminative performance, calibration, and ease of calculation, the PROGRESS-CTO complication scores could help assess the risk of complications in patients undergoing CTO PCI.
