The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Comparison of the novel EuroCTO (CASTLE) score with the J-CTO score for predicting technical success of chronic total occlusions percutaneous revascularization

DOI: 10.4244/EIJ-D-19-00352


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Aims: We sought to compare the efficiency of the novel EuroCTO (CASTLE) score with the commonly used Multicentre CTO registry in Japan (J-CTO) score in predicting procedural success of percutaneous recanalization (PCI) for coronary chronic total occlusions (CTOs). 

Methods and results: We evaluated 660 consecutive CTO PCIs (mean age: 66±11 years, 84% male). The mean J-CTO and EuroCTO (CASTLE) scores were 1.86 ± 1.2 and 1.74 ± 1.2, respectively. Antegrade wire escalation, antegrade dissection re-entry and retrograde approach were used in 82%, 14% and 37% of cases, respectively. Receiver-operator characteristic analysis demonstrated equal overall discriminatory capacity between the two scores (AUC: 0.698, 95%CI: 0.653-0.742 p<0.001 for J-CTO vs. AUC: 0.676, 95%: CI 0.627-0.725, p<0.001 for EuroCTO; AUC difference: 0.022, p=0.5). However, for more complex procedures [(J-CTO ³ 3 or EuroCTO (CASTLE) ³ 4)], the predictive capacity of EuroCTO (CASTLE) score appeared superior (AUC: 0.588, 95% CI 0.509-0.668, p=0.03 for EuroCTO (CASTLE) score vs. AUC: 0.473, 95% CI 0.393-0.553, p=NS for the J-CTO score, AUC difference: 0.115, p=0.04) 

Conclusions: In this study, the novel EuroCTO (CASTLE) score was comparable to the J-CTO score in predicting CTO PCI outcome with a superior discriminatory capacity for the more complex cases.

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