Development and validation of a scoring system for predicting clinical coronary artery perforation during percutaneous coronary intervention of chronic total occlusions: the PROGRESS-CTO perforation score

DOI: 10.4244/EIJ-D-22-00593

Spyridon Kostantinis
Spyridon Kostantinis1, MD; Bahadir Simsek1, MD; Judit Karacsonyi1, MD, PhD; Khaldoon Alaswad2, MD; Farouc A. Jaffer3, MD, PhD; Jaikirshan J. Khatri4, MD; James W. Choi5, MD; Wissam A. Jaber6, MD; Stéphane Rinfret6, MD; William Nicholson6, MD; Mitul P. Patel7, MD; Ehtisham Mahmud7, MD; Catalin Toma8, MD; Rhian E. Davies9, DO; Jimmy L. Kerrigan10, MD; Elias V. Haddad10, MD; Sevket Gorgulu11, MD; Nidal Abi-Rafeh12, MD; Ahmed M. ElGuindy13, MD; Omer Goktekin14, MD; Salman Allana1, MD; M. Nicholas Burke1, MD; Olga C. Mastrodemos1, BA; Bavana V. Rangan1, MPH, BDS; Emmanouil S. Brilakis1, MD, PhD
1. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA; 2. Cardiovascular Division, Henry Ford Hospital, Detroit, MI, USA; 3. Massachusetts General Hospital, Boston, MA, USA; 4. Cleveland Clinic, Cleveland, OH, USA; 5. Texas Health Presbyterian Hospital, Dallas, TX, USA; 6. Emory University Hospital Midtown, Atlanta, GA, USA; 7. UCSD Medical Center, La Jolla, CA, USA; 8. University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 9. Wellspan York Hospital, York, PA, USA; 10. Ascension Saint Thomas Heart Hospital, Nashville, TN, USA; 11. Biruni University Medical School, Istanbul, Turkey; 12. North Oaks Health System, Hammond, LA, USA; 13. Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt; 14. Memorial Bahcelievler Hospital, Istanbul, Turkey

Background: Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and often leads to serious adverse clinical events.

Aims: We sought to develop a risk score to predict clinical coronary artery perforation in patients undergoing CTO PCI.

Methods: We analysed clinical and angiographic parameters from 9,618 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO). Logistic regression prediction modelling was used to identify variables independently associated with clinical perforation, and the model was internally validated with bootstrapping. Clinical coronary artery perforation was defined as any perforation requiring treatment.

Results: The incidence of clinical coronary perforation was 3.8% (n=367). Five factors were independently associated with perforation and were included in the score: patient age ≥65 years +1 point (odds ratio [OR] 1.79, 95% confidence interval [CI]: 1.37-2.33), moderate/severe calcification +1 point (OR 1.85, 95% CI: 1.41-2.42), blunt/no stump +1 point (OR 1.45, 95% CI: 1.10-1.92), use of antegrade dissection and re-entry +1 point (OR 2.43, 95% CI: 1.61-3.69), and use of the retrograde approach +2 points (OR 4.02, 95% CI: 2.95-5.46). The resulting score showed acceptable performance on receiver operating characteristic (ROC) curve (area under the curve [AUC]: 0.741, 95% CI: 0.712-0.773). The Hosmer-Lemeshow test indicated a good fit (p=0.991), and internal validation with bootstrapping demonstrated good agreement with the model with observed AUC: 0.736 (95% bias-corrected CI: 0.706-0.767).

Conclusions: The PROGRESS-CTO perforation score may be a useful tool for predicting clinical coronary perforation during CTO PCI.

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chronic coronary total occlusionCoronary rupturepericardial effusion
CTO
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