Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score

Zsolt Szijgyarto; Rajiv Rampat; Gerald S. Werner; Claudius Ho; Nicolaus Reifart; Thierry Lefevre; Yves Louvard; Alexandre Avran; Mashayekhi Kambis; Heinz-Joachim Buettner; Carlo Di Mario; Anthony Gershlick; Javier Escaned; George Sianos; Alfredo Galassi; Roberto Garbo; Omer Goktekin; Marcus Meyer-Gessner; Bernward Lauer; Simon Elhadad; Alexander Bufe; Nicolas Boudou; Horst Sievert; Victoria Martin-Yuste; Leif Thuesen; Andrejs Erglis; Evald Christiansen; James Spratt; Lesciak Bryniarski; Tim Clayton; David Hildick-Smith

doi:10.1016/j.jcin.2018.11.020

JACC: Cardiovascular Interventions

January 2019 DOI: 10.1016/j.jcin.2018.11.020

Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry
The EuroCTO (CASTLE) Score

Zsolt Szijgyarto, Rajiv Rampat, Gerald S. Werner, Claudius Ho, Nicolaus Reifart, Thierry Lefevre, Yves Louvard, Alexandre Avran, Mashayekhi Kambis, Heinz-Joachim Buettner, Carlo Di Mario, Anthony Gershlick, Javier Escaned, George Sianos, Alfredo Galassi, Roberto Garbo, Omer Goktekin, Marcus Meyer-Gessner, Bernward Lauer, Simon Elhadad, Alexander Bufe, Nicolas Boudou, Horst Sievert, Victoria Martin-Yuste, Leif Thuesen, Andrejs Erglis, Evald Christiansen, James Spratt, Lesciak Bryniarski, Tim Clayton and David Hildick-Smith

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Author + information

DOI:

https://doi.org/10.1016/j.jcin.2018.11.020

Published By:

JACC: Cardiovascular Interventions

Print ISSN:

1936-8798

Online ISSN:

1876-7605

History:

Received September 5, 2018
Revision received October 9, 2018
Accepted November 13, 2018
Published online January 30, 2019.

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2019 American College of Cardiology Foundation

Author Information

Zsolt Szijgyarto, PhD^a,
Rajiv Rampat, MD^b,
Gerald S. Werner, MD, PhD^c,
Claudius Ho, MBBS^b,
Nicolaus Reifart, MD, PhD^d,
Thierry Lefevre, MD^e,
Yves Louvard, MD^e,
Alexandre Avran, MD^f,
Mashayekhi Kambis, MD^g,
Heinz-Joachim Buettner, MD^g,
Carlo Di Mario, MD, PhD^h,
Anthony Gershlick, MD, PhDⁱ,
Javier Escaned, MD, PhD^j,
George Sianos, MD, PhD^k,
Alfredo Galassi, MD^l,
Roberto Garbo, MD^m,
Omer Goktekin, MDⁿ,
Marcus Meyer-Gessner, MD^o,
Bernward Lauer, MD^p,
Simon Elhadad, MD^q,
Alexander Bufe, MD^r,
Nicolas Boudou, MD^s,
Horst Sievert, MD^t,
Victoria Martin-Yuste, MD^u,
Leif Thuesen, MD, DMSc^v,
Andrejs Erglis, MD^w,
Evald Christiansen, MD, PhD^x,
James Spratt, MD^y,
Lesciak Bryniarski, MD, PhD^z,
Tim Clayton, PhD^a and
David Hildick-Smith, MD^b,^∗ (david.hildick-smith{at}bsuh.nhs.uk)

^aLondon School of Hygiene and Tropical Medicine, London, United Kingdom
^bSussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
^cDepartment of Cardiology & Intensive Care, Klinikum Darmstadt, Darmstadt, Germany
^dDepartment of Cardiology, Main Taunus Heart Institute, Frankfurt am Main, Germany
^eDepartment of Cardiology, Institut Cardiovasculaire Paris Sud, Paris, France
^fDepartment of Cardiology, Arnault Tzanck Institut, Saint Laurent du Var, France
^gDivision of Cardiology and Angiology II, University Heart Center Freiburg, Freiburg, Germany
^hStructural Interventional Cardiology, Careggi University Hospital, Florence, Italy
ⁱDepartment of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
^jHospital Clinico San Carlos IDISSC and Complutense, Madrid, Spain
^k1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
^lDepartment of Experimental and Clinical Medicine, University of Catania, Catania, Italy
^mInterventional Cardiology Unit, San Giovanni Bosco Hospital, Torino, Italy
ⁿDepartment of Cardiology, Istanbul Memorial Hospital, Istanbul, Turkey
^oDepartment of Cardiology, Augusta Krankenhaus, Düsseldorf, Germany
^pDepartment of Cardiology, Kardiologie Zentralklinik, Bad Berka, Germany
^qDepartment of Cardiology, Centre Hospitalier de Marne-la-vallée, Jossigny, France
^rHelios Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
^sCardiology Department, Rangueil University Hospital, Toulouse, France
^tDepartment of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany
^uDepartment of Cardiology, Hospital Clínic Barcelona, Barcelona, Spain
^vDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark
^wPauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
^xDepartment of Cardiology B, Aarhus University Hospital, Aarhus, Denmark
^yDepartment of Cardiology, St. George's University NHS Trust, London, United Kingdom
^zDepartment of Cardiology, Interventional Electrocardiology and Hypertension Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland

↵∗Address for correspondence:
Dr. David Hildick-Smith, Sussex Cardiac Centre, Brighton, United Kingdom.

Graphical abstract

Abstract

Objectives The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty.

Background Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making.

Methods The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure.

Results There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass grafting history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets.

Conclusions The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.

Key Words

Footnotes

Dr. Sievert has received study honoraria, travel expenses, and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Celonova, Comed BV, Contego, CVRx, Edwards, Endologix, Hemoteq, Lifetech, Maquet Getinge Group, Medtronic, Mitralign, Nuomao Medtech, Occlutech, pfm Medical, Recor, Renal Guard, Rox Medical, Terumo, Vascular Dynamics, and Vivasure Medical. Dr. Hildick-Smith has served on the advisory board for Abbott, Terumo, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Received September 5, 2018.
Revision received October 9, 2018.
Accepted November 13, 2018.

2019 American College of Cardiology Foundation

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