Clinic of Cardiovascular diseases, Riga East University Hospital, Riga, LV 1038, Latvia.
Department of Public Health and Epidemiology, Riga Stradins University, Riga, LV 1007, Latvia.
Medicina (Kaunas). 2019 Aug 16;55(8):494. doi: 10.3390/medicina55080494.
Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure. A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan-Meier method and Cox regression were used to estimate the association with death from any cause after a successful procedure, 454 of 551cases were successful. With increasing disease complexity, the procedural success rate was significantly reduced in all scoring systems ( < 0.001): Area under the curve was 0.714 for J CTO score, 0.605 for PROGRESS CTO, 0.624 for CL and 0.641 for CASTLE scores. During the median 6.8 years of follow-up time, survival was better in the successful procedure group ( = 0.041). Among patients with procedural success, only PROGRESS and CASTLE scores showed an association with all-cause risk of death. After adjustment for baseline characteristics, patients having high PROGRESS score had almost twice higher risk of death (HR 1.81(95% CI 1.19-2.75)), and those with high and intermediate CASTLE score experienced almost four (HR 3.68(95% CI 1.50-9.05)) and two (HR 2.15, (95% CI 1.42-3.23)) times higher risk of death than the low score patients, respectively. All four CTO scoring systems had moderate ability to predict procedural success. More complex CTO PCI patients, assessed by PROGRESS and CASTLE scores, has worse all-cause survival in six to seven years after a successful procedure; whereas J CTO and CL scores had no association with survival.
不同的评分系统用于根据疾病的复杂性对慢性完全闭塞性冠状动脉病变（CTO）患者进行分层，以预测经皮冠状动脉介入治疗（PCI）的成功率。不同 CTO 评分系统之间的比较以及 CTO 患者 PCI 后的长期结果尚未得到很好的建立。本研究的目的是评估不同疾病严重程度评分系统预测以下情况的能力：首先，预测程序成功，其次，预测程序成功患者的总体生存率。
共有 551 例患者于 2007 年 1 月至 2016 年 12 月在里加东大学医院接受选择性 CTO PCI 治疗，纳入本研究。计算了 4 种评分系统（J CTO、PROGRESS CTO、CL 和 CASTLE）。ROC 曲线用于评估评分与程序成功之间的关系，Kaplan-Meier 法和 Cox 回归用于估计与成功程序后任何原因死亡的关系。551 例中有 454 例成功。随着疾病复杂性的增加，所有评分系统的程序成功率均显著降低（<0.001）：J CTO 评分的曲线下面积为 0.714，PROGRESS CTO 评分的曲线下面积为 0.605，CL 评分的曲线下面积为 0.624，CASTLE 评分的曲线下面积为 0.641。在中位 6.8 年的随访期间，成功程序组的生存率更好（=0.041）。在程序成功的患者中，只有 PROGRESS 和 CASTLE 评分与全因死亡风险相关。在调整基线特征后，高 PROGRESS 评分患者的死亡风险几乎增加了两倍（HR 1.81（95%CI 1.19-2.75）），而高和中 CASTLE 评分患者的死亡风险分别增加了近四倍（HR 3.68（95%CI 1.50-9.05））和两倍（HR 2.15，（95%CI 1.42-3.23））与低评分患者相比。所有四种 CTO 评分系统均具有中等能力预测程序成功。根据 PROGRESS 和 CASTLE 评分评估的更复杂的 CTO PCI 患者，在成功程序后 6 至 7 年内全因死亡率较差；而 J CTO 和 CL 评分与生存率无关。
