Azzalini Lorenzo, Hirai Taishi, Salisbury Adam, Gosch Kensey, Sapontis James, Nicholson William J, Karmpaliotis Dimitri, Moses Jeffrey W, Kearney Kathleen E, Lombardi William L, Grantham James Aaron
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.
Department of Medicine, Division of Cardiology, University of Missouri, Columbia, Missouri, USA.
Catheter Cardiovasc Interv. 2023 Feb;101(3):536-542. doi: 10.1002/ccd.30563. Epub 2023 Jan 22.
Risk stratification before chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is important to inform procedural planning as well as patients and their families. We sought to externally validate the PROGRESS-CTO complication risk scores in the OPEN-CTO registry.
OPEN-CTO is a prospective registry of 1000 consecutive CTO PCIs performed at 12 experienced US centers using the hybrid algorithm. Endpoints of interest were in-hospital all-cause mortality, need for pericardiocentesis, acute myocardial infarction (MI), and major adverse cardiovascular events (MACE) (a composite of all-cause mortality, stroke, periprocedural MI, urgent repeat revascularization, and tamponade requiring pericardiocentesis). Model discrimination was assessed with the area under the curve (AUC) method, and calibration with the observed-versus-predicted probability method.
Mean age was 65.4 ± 10.3 year, and 36.5% of patients had prior coronary artery bypass graft. Overall, 41 patients (4.1%) suffered MACE, 9 (0.9%) mortality, 26 (2.6%) acute MI, and 11 (1.1%) required pericardiocentesis. Technical success was achieved in 86.3%. Patients who experienced MACE had higher anatomic complexity, and more often required antegrade dissection/reentry and the retrograde approach. Increasing PROGRESS-CTO MACE scores were associated with increasing MACE rates: 0.5% (score 0-1), 2.4% (score 2), 3.7% (score 3), 4.5% (score 4), 7.8% (score 5), 13.0% (score 6-7). The AUC were as follows: MACE 0.72 (95% confidence interval [CI]: 0.66-0.78), mortality 0.79 (95% CI: 0.66-0.95), pericardiocentesis 0.71 (95% CI: 0.60-0.82), and acute MI 0.57 (95% CI: 0.49-0.66). Calibration was adequate for MACE and mortality, while the models underestimated the risk of pericardiocentesis and acute MI.
In a large external cohort of patients treated with the hybrid algorithm by experienced CTO operators, the PROGRESS-CTO MACE, mortality, and pericardiocentesis risk scores showed good discrimination, while the acute MI score had inferior performance.
在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）前进行风险分层对于指导手术规划以及告知患者及其家属非常重要。我们试图在OPEN-CTO注册研究中对PROGRESS-CTO并发症风险评分进行外部验证。
OPEN-CTO是一项前瞻性注册研究，在美国12个经验丰富的中心连续进行了1000例CTO PCI，采用混合算法。感兴趣的终点包括院内全因死亡率、心包穿刺术需求、急性心肌梗死（MI）和主要不良心血管事件（MACE）（全因死亡率、中风、围手术期MI、紧急重复血运重建以及需要心包穿刺术的心包填塞的综合）。采用曲线下面积（AUC）方法评估模型辨别能力，采用观察概率与预测概率方法评估校准情况。
平均年龄为65.4±10.3岁，36.5%的患者曾接受冠状动脉旁路移植术。总体而言，41例患者（4.1%）发生MACE，9例（0.9%）死亡，26例（2.6%）发生急性MI，11例（1.1%）需要心包穿刺术。技术成功率为86.3%。发生MACE的患者解剖复杂性更高，更常需要顺行夹层分离/再入路和逆行入路。PROGRESS-CTO MACE评分增加与MACE发生率增加相关：0.5%（评分0-1）, 2.4%（评分2）, 3.7%（评分3）, 4.5%（评分4）, 7.8%（评分5）, 13.0%（评分6-7）。AUC如下：MACE为0.72（95%置信区间[CI]：0.66-0.78），死亡率为0.79（95%CI：0.66-0.95），心包穿刺术为0.71（95%CI：0.60-0.82），急性MI为0.57（95%CI：0.49-0.66）。MACE和死亡率的校准情况良好，而模型低估了心包穿刺术和急性MI的风险。
在由经验丰富的CTO手术医生采用混合算法治疗的大型外部患者队列中，PROGRESS-CTO MACE、死亡率和心包穿刺术风险评分显示出良好的辨别能力，而急性MI评分表现较差。
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