Cardiovascular Center, Tokeidai Memorial Hospital, Sapporo, Japan.
Department of Cardiology, Kameda Medical Center, Chiba, Japan.
J Vasc Surg. 2021 Aug;74(2):506-513.e2. doi: 10.1016/j.jvs.2021.01.059. Epub 2021 Feb 16.
To develop a scoring system that can adequately predict a successful guidewire crossing (S-GC) of below-the-knee (BTK) chronic total occlusions (CTOs) in angiographic evaluation.
A retrospective, multicenter, nonrandomized study examined 448 consecutive BTK CTOs in 299 patients treated with endovascular therapy in seven Japanese medical centers from April 2012 to April 2020. The cohort was classified into two groups: an S-GC group and a failed guidewire crossing group.
The final logistic regression model created by a backward stepwise multivariate logistic regression model included five variables: "No outflow of the target vessel," "CTO length ≥200 mm," "Reference vessel diameter <2.0 mm," "Calcification at the proximal entry point," and "Blunt type at entry point." Optimisms were adjusted using 1000 bootstrap samples with replacement and candidate's risk score models developed according to optimism-adjusted correlation coefficients of risk factors. Choosing the best model as the Japanese-BTK (J-BTK) CTO score by comparing the optimism-adjusted area under receiver-operating characteristic curves it was decided to assign one point to "Blunt type at the proximal entry point," one point to "Calcification at the proximal entry point," one point to "Reference vessel diameter <2.0 mm," one point to "CTO length ≥200 mm," and two points to "No outflow of the target vessel." This rule was then used to categorize BTK CTOs into four grades with varying probabilities of S-GC: grade A (J-BTK CTO score of 0 and 1), grade B (score of 2 and 3), grade C (score of 4 and 5), and grade D (score of 6). Rates of S-GC in each grade (grades A, B, C, and D) were 97.3%, 76.8%, 19.3%, and 0%, respectively. Lesions categorized as grade C or D have a lower chance of S-GC. Internal validation was performed using the Hosmer-Lemeshow test (P = .99).
The J-BTK CTO score predicts the probability of an S-GC of BTK CTOs and stratifies the difficulty of endovascular therapy for BTK CTOs in angiographic evaluation.
开发一种评分系统，能够充分预测经影像学评估的膝下（BTK）慢性完全闭塞（CTO）的导丝成功穿越（S-GC）。
本回顾性、多中心、非随机研究纳入了 2012 年 4 月至 2020 年 4 月在日本 7 家医疗中心接受血管内治疗的 299 例 448 例连续 BTK CTO 患者，将其分为 S-GC 组和导丝失败穿越组。
采用后向逐步多元逻辑回归模型建立的最终逻辑回归模型包括 5 个变量：“靶血管无血流”、“CTO 长度≥200mm”、“参照血管直径＜2.0mm”、“近端入路处钙化”和“入路处为钝形”。采用 1000 次有放回的 bootstrap 样本进行乐观调整，并根据危险因素的乐观调整相关系数开发候选风险评分模型。通过比较乐观调整后的受试者工作特征曲线下面积，选择最佳模型作为日本 BTK（J-BTK）CTO 评分，决定给“近端入路处为钝形”记 1 分，“近端入路处钙化”记 1 分，“参照血管直径＜2.0mm”记 1 分，“CTO 长度≥200mm”记 1 分，“靶血管无血流”记 2 分。然后，根据这一规则将 BTK CTO 分为四级，S-GC 的概率各不相同：A级（J-BTK CTO 评分 0 分和 1 分）、B 级（评分 2 分和 3 分）、C 级（评分 4 分和 5 分）和 D 级（评分 6 分）。每个等级（A、B、C 和 D）的 S-GC 率分别为 97.3%、76.8%、19.3%和 0%。分类为 C 级或 D 级的病变 S-GC 的可能性较低。采用 Hosmer-Lemeshow 检验进行内部验证（P=0.99）。
J-BTK CTO 评分可预测 BTK CTO 的 S-GC 概率，并对 BTK CTO 血管内治疗的难度进行影像学评估分层。
