Nombela-Franco Luis, Urena Marina, Jerez-Valero Miguel, Nguyen Can Manh, Ribeiro Henrique Barbosa, Bataille Yoann, Rodés-Cabau Josep, Rinfret Stéphane
From the Multidisciplinary Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada.
Circ Cardiovasc Interv. 2013 Dec;6(6):635-43. doi: 10.1161/CIRCINTERVENTIONS.113.000447. Epub 2013 Nov 19.
Chronic total occlusion (CTO) recanalization is a complex and technically challenging procedure. The J-CTO score has been proposed to stratify case complexity and procedural success rates. However, the score has never been tested outside the setting of the original study. Moreover, its predictive value when using a hybrid antegrade or retrograde approach is unknown. We investigated the performance of the J-CTO score for predicting procedure complexity and success in an independent contemporary cohort.
A total of 209 consecutive patients who underwent CTO recanalization by a high-volume operator were included. Clinical and angiographic data were prospectively collected. The J-CTO score was applied for each patient, and discrimination and calibration were evaluated in the whole cohort, and according to the approach (antegrade 47% and retrograde 53%). Clinical and angiographic differences were noted between the original and studied cohort. The mean J-CTO score was 2.18±1.26, and successful guidewire crossing within 30 minutes and final angiographic success were 44.5% and 90.4%, respectively. The J-CTO score demonstrated good discrimination (c statistic, >0.70) and calibration (Hosmer-Lemeshow P>0.1) in the whole cohort and for antegrade and retrograde approaches. However, the final success rate was not associated with the J-CTO score.
In this independent cohort, the J-CTO score showed good discriminatory and calibration capacity for guidewire CTO crossing within 30 minutes but it does not for final success rate. The J-CTO score helps to predict complexity of CTO recanalization, and the simplicity of the score supports the widespread use as a clinical tool.
慢性完全闭塞病变（CTO）再通是一项复杂且技术要求高的操作。J-CTO评分被提出用于对病例复杂性和手术成功率进行分层。然而，该评分从未在原研究背景之外进行过测试。此外，其在使用杂交顺行或逆行方法时的预测价值尚不清楚。我们在一个独立的当代队列中研究了J-CTO评分预测手术复杂性和成功率的性能。
纳入了209例由一位高手术量操作者进行CTO再通的连续患者。前瞻性收集临床和血管造影数据。对每位患者应用J-CTO评分，并在整个队列中以及根据手术方法（顺行47%，逆行53%）评估区分度和校准度。记录原队列和研究队列之间的临床和血管造影差异。J-CTO评分的平均值为2.18±1.26，30分钟内成功通过导丝和最终血管造影成功的比例分别为44.5%和90.4%。J-CTO评分在整个队列以及顺行和逆行方法中均显示出良好的区分度（c统计量，>0.70）和校准度（Hosmer-Lemeshow P>0.1）。然而，最终成功率与J-CTO评分无关。
在这个独立队列中，J-CTO评分在30分钟内对CTO导丝通过显示出良好的区分和校准能力，但对最终成功率则不然。J-CTO评分有助于预测CTO再通的复杂性，且该评分的简单性支持其作为一种临床工具被广泛应用。
