Nomogram to Predict Successful Septal Collateral Crossing during Percutaneous Coronary Intervention of Chronic Total Occlusion by retrograde approach: The Sep-CTO score

Septal collaterals are the main collaterals used in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, there is little evidence regarding the selection of an interventional septal collateral (SC). we aimed to identify the predictors of successful guidewire crossing using clinical and anatomical characteristics. Overall, 216 derivation cases and 86 validation cases that included retrograde CTO PCI were analyzed. The technical success rate was 79.1% and there were no significant differences in the Gensini score, SYNTAX score, J-CTO score and Progress Score between two groups. Multivariate logistic regression analysis revealed that diabetes, small size, corkscrew, and side branch at tortuosity were independent factors of success in crossing SCs. We developed a nomogram to predict the success rate, which demonstrates favorable calibration and formed the Sep-CTO score. The calibration and decision curve analysis also demonstrated the reliability and accuracy of this clinical prediction model. The receiver-operating characteristic area of the nomogram was 0.870. Compared to the aforementioned scoring systems, Sep-CTO score was the most powerful. The nomogram may be a useful clinical tool. We found four independent variables to predict the successful guidewire crossing in septal collaterals.

[1]  F. Welt,et al.  Should Interventional Cardiologists Super-Subspecialize?: Moving From Patient Selection to Operator Selection. , 2021, JACC. Cardiovascular interventions.

[2]  S. Garcia,et al.  Technical and procedural outcomes of the retrograde approach to chronic total occlusion interventions , 2020, EuroIntervention.

[3]  Masafumi Ueno,et al.  Retrograde-angioscopy guided wiring technique in chronic total occlusion lead to successful revascularization. , 2020, Journal of cardiology cases.

[4]  Y. Tsai,et al.  Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus , 2020, Cardiovascular Diabetology.

[5]  P. Serruys,et al.  Did the SYNTAX Score Pass the Test of Time? , 2020, JACC. Cardiovascular interventions.

[6]  S. Sumitsuji,et al.  Successful guidewire crossing via collateral channel at retrograde percutaneous coronary intervention for chronic total occlusion: the J-Channel score , 2020 .

[7]  J. Garber,et al.  CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2020 EXECUTIVE SUMMARY. , 2020, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[8]  A. Giannopoulos,et al.  A guide for Gensini Score calculation. , 2019, Atherosclerosis.

[9]  J. Spertus,et al.  Depression and Angina Among Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention: The OPEN-CTO Registry. , 2019, JACC. Cardiovascular interventions.

[10]  Corrigendum to: 2018 ESC/ESH Guidelines for the management of arterial hypertension. , 2018, European heart journal.

[11]  W. Shen,et al.  Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion , 2018, Cardiovascular Diabetology.

[12]  Bin Zhang,et al.  Epicardial collateral channel for retrograded recanalization of chronic total occlusion percutaneous coronary intervention: Predictors of failure and procedural outcome , 2018, Journal of interventional cardiology.

[13]  C. Hung,et al.  Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion , 2018, Circulation. Cardiovascular interventions.

[14]  A. Colombo,et al.  Outcomes of the retrograde approach through epicardial versus non-epicardial collaterals in chronic total occlusion percutaneous coronary intervention. , 2017, Cardiovascular revascularization medicine : including molecular interventions.

[15]  Eliot A Brinton,et al.  AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE. , 2017, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[16]  C. Hung,et al.  Retrograde Approach is as Effective and Safe as Antegrade Approach in Contemporary Percutaneous Coronary Intervention for Chronic Total Occlusion: A Taiwan Single-Center Registry Study. , 2017, Acta Cardiologica Sinica.

[17]  S. Garcia,et al.  Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score , 2016, Journal of the American Heart Association.

[18]  J. Spratt,et al.  The collateral circulation of coronary chronic total occlusions. , 2016, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[19]  Bin Zhang,et al.  Clinical Prediction Score for Successful Retrograde Procedure in Chronic Total Occlusion Percutaneous Coronary Intervention , 2016, Cardiology.

[20]  E. Brilakis,et al.  A percutaneous treatment algorithm for crossing coronary chronic total occlusions. , 2012, JACC. Cardiovascular interventions.

[21]  Y. Hayashi,et al.  Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. , 2011, JACC. Cardiovascular interventions.