Journalartikel
Autorenliste: Opolski, Maksymilian P.; Achenbach, Stephan; Schuhbaeck, Annika; Rolf, Andreas; Moellmann, Helge; Nef, Holger; Rixe, Johannes; Renker, Matthias; Witkowski, Adam; Kepka, Cezary; Walther, Claudia; Schlundt, Christian; Debski, Artur; Jakubczyk, Michal; Hamm, Christian W.
Jahr der Veröffentlichung: 2015
Seiten: 257-267
Zeitschrift: JACC: Cardiovascular Interventions
Bandnummer: 8
Heftnummer: 2
ISSN: 1936-8798
eISSN: 1876-7605
Open Access Status: Bronze
DOI Link: https://doi.org/10.1016/j.jcin.2014.07.031
Verlag: Elsevier
Abstract:
OBJECTIVES This study sought to establish a coronary computed tomography angiography prediction rule for grading chronic total occlusion (CTO) difficulty for percutaneous coronary intervention (PCI).
BACKGROUND The uncertainty of procedural outcome remains the strongest barrier to PCI in CTO.
METHODS Data from 4 centers involving 240 consecutive CTO lesions with pre-procedural coronary computed tomography angiography were analyzed. Successful guidewire (GW) crossing <= 30 min was set as an endpoint to eliminate operator bias. The CT-RECTOR (Computed Tomography Registry of Chronic Total Occlusion Revascularization) score was developed by assigning 1 point for each independent predictor, and then summing all points accrued. Continuous distribution of scores was used to stratify CTO into 4 difficulty groups: easy (score 0); intermediate (score 1); difficult (score 2); and very difficult (score >= 3). Discriminatory performance was tested by 10-fold cross-validation and compared with the angiographic J-CTO (Multicenter CTO Registry of Japan) score.
RESULTS Study endpoint was achieved in 55% of cases. Multivariable analysis yielded multiple occlusions, blunt stump, severe calcification, bending, duration of CTO >= 12 months, and previously failed PCI as independent predictors for GW crossing. The probability of successful GW crossing <= 30min for each group (from easy to very difficult) was 95%, 88%, 57%, and 22%, respectively. Areas under receiver-operator characteristic curves for the CT-RECTOR and J-CTO scores were 0.83 and 0.71, respectively (p < 0.001). Both the original model fit and 10-fold cross-validation correctly classified 77.3% of lesions.
CONCLUSIONS The CT-RECTOR score represents a simple and accurate noninvasive tool for predicting time-efficient GW crossing that may aid in grading CTO difficulty before PCI. (Computed Tomography Angiography Prediction Score for Percutaneous Revascularization for Chronic Total Occlusions [CT-RECTOR]; NCT02022878) (C) 2015 by the American College of Cardiology Foundation.
Zitierstile
Harvard-Zitierstil: Opolski, M., Achenbach, S., Schuhbaeck, A., Rolf, A., Moellmann, H., Nef, H., et al. (2015) Coronary Computed Tomographic Prediction Rule for Time-Efficient Guidewire Crossing Through Chronic Total Occlusion Insights From the CT-RECTOR Multicenter Registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization), JACC: Cardiovascular Interventions, 8(2), pp. 257-267. https://doi.org/10.1016/j.jcin.2014.07.031
APA-Zitierstil: Opolski, M., Achenbach, S., Schuhbaeck, A., Rolf, A., Moellmann, H., Nef, H., Rixe, J., Renker, M., Witkowski, A., Kepka, C., Walther, C., Schlundt, C., Debski, A., Jakubczyk, M., & Hamm, C. (2015). Coronary Computed Tomographic Prediction Rule for Time-Efficient Guidewire Crossing Through Chronic Total Occlusion Insights From the CT-RECTOR Multicenter Registry (Computed Tomography Registry of Chronic Total Occlusion Revascularization). JACC: Cardiovascular Interventions. 8(2), 257-267. https://doi.org/10.1016/j.jcin.2014.07.031
Schlagwörter
ANGIOPLASTY; ARTERY-OCCLUSION; chronic total occlusion; clinical prediction rule; Coronary computed tomography angiography; DIFFICULTY; IN-HOSPITAL OUTCOMES; PERCUTANEOUS CORONARY INTERVENTION; RECANALIZATION
