The impact of J-CTO score on in-stent chronic total occlusion percutaneous coronary intervention.

Abstract

The purpose of this study was to investigate the impact of J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) score on in-stent chronic total occlusion (IS-CTO) percutaneous coronary intervention (PCI). A retrospective data collection was conducted on 474 patients undergoing a difficult IS-CTO PCI from January 2015 to December 2018. The primary endpoint (major adverse cardiovascular events [MACE]) consisted of target-vessel myocardial infarction (MI), cardiac death or ischemia-driven target-vessel revascularisation (TVR) at follow-up. The cut-off points were estimated by the Youden index. The overall procedural success rate was 77.6%. On multivariable analysis, factors including proximal bending (beta coefficient [β] = 3.465), tortuosity (β=3.064), stent under expansion (β=3.109) and poor distal landing zone (β=1.959) were associated with technical failure via antegrade approach but not the J-CTO score (OR = 0.632; 95% CI [0.352-1.134]; P=.124). After a median follow-up of 30months (interquartile range: 17-42months), multivariable analysis revealed that receiving >18months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of MACE (HR: 2.690; 95% CI: 1.346-5.347; P=.005). But the J-CTO score was not an independent predictor of MACE (HR: 1.018; 95% CI: 0.728-1.424; P=.917). J-CTO score system is not a helpful tool to predict the technical success of difficult IS-CTO PCI via antegrade approach, nor does it correlate with long-term outcomes in patients undergoing IS-CTO PCI. Nevertheless, factors associated with technical failure include proximal bending of ≥30 degrees, under expansion of ≥10mm, moderate or severe tortuosity (bending) ≥20 and poor distal target. Long-term DAPT therapy contributes significantly to decreased MACE.