Castle Score Versus J-CTO Score for The Prediction of Technical Success in Chronic Total Occlusion Percutaneous Revascularization

Abstract

Background: Chronic total occlusions (CTOs) present a significant challenge in percutaneous coronary intervention (PCI). Accurate preprocedural assessment and planning are crucial for the success of these interventions. The J-CTO score has been widely used to predict the success of PCI in CTO cases, but recent developments have introduced the EuroCTO (CASTLE) score, which may offer advantages in complex cases. Objective: This study aimed to compare the predictive accuracy of the EuroCTO (CASTLE) score with the J-CTO score in determining the success of PCI in CTO cases, with a focus on their utility in preprocedural planning and risk assessment. Methods: Conducted at a tertiary cardiac care center in Rawalpindi, Pakistan, this analytical cross-sectional study involved 120 patients undergoing PCI for CTO from January 2023 to November 2023. Inclusion criteria were patients aged 18-80 years requiring PCI for CTO, while patients with acute coronary syndromes, pregnant women, or those refusing consent were excluded. Data on clinical, angiographic, and procedural characteristics were systematically recorded. The EuroCTO (CASTLE) and J-CTO scores were calculated based on established algorithms. Technical success was defined as effective revascularization of the CTO lesion with less than 30% residual stenosis and TIMI grade 3 antegrade flow restoration. Statistical analysis was conducted using SPSS 25. Results: The mean age of the participants was 58.85 ± 11.1 years, with a male predominance (62.5%). Hypertension (67.5%) and hyperlipidemia (78.3%) were common comorbidities. The mean procedural time was 132.42 ± 5.11 minutes, and the mean fluoroscopy time was 41.19 ± 2.41 minutes. The J-CTO and EuroCTO (CASTLE) scores were 2.09 ± 0.70 and 1.91 ± 0.69, respectively. Multivariate logistic regression analysis showed comparable predictive performance between the two scores, with slightly better discriminative ability in complex cases for the EuroCTO (CASTLE) score. Conclusion: Both the EuroCTO (CASTLE) and J-CTO scores effectively predict the success of PCI in CTO cases, with the EuroCTO (CASTLE) score showing potential advantages in more complex scenarios. These scoring systems are valuable tools for clinicians in preprocedural planning and risk assessment, enhancing the decision-making process in CTO interventions.