B-20 | Assessment of the ERCTO Score for Predicting Success in Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions in the PROGRESS-CTO Registry

Abstract

The retrograde strategy is a common approach used in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The ERCTO Retrograde score is a tool that aims to predict the likelihood of technical success for retrograde CTO PCI procedures by evaluating five parameters: calcification, distal opacification, proximal tortuosity, collateral connection classification, and operator volume. We evaluated the performance of the ERCTO Retrograde score using data from 2,341 patients enrolled in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) at 35 centers between 2013 and 2023. Retrograde CTO PCI was the primary crossing strategy in 871 cases (37.2%) and a secondary crossing strategy in 1,467 cases (62.8%). Technical success was achieved in 1,810 cases (77.3%). The technical success rate was higher for primary retrograde cases compared with secondary retrograde cases (79.8% vs 75.9%; p=0.031). The ERCTO Retrograde score was positively associated with the likelihood of procedural success. The c-statistic of the ERCTO retrograde score was 0.636 (95% confidence intervals [CI]: 0.610 – 0.662) for all cases and 0.651 (95% CI: 0.607 – 0.695) for primary retrograde cases. The ERCTO Retrograde score has modest predictive capacity for technical success in retrograde CTO PCI.