The J-CTO Score Remains Predictive of Procedural Success for Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI) in a Contemporary Australian Cohort

Abstract

Aims: The J-CTO score is an easily calculated clinical tool which can predict the success of CTO PCI. However, it is unknown whether this score remains relevant in the context of the modern techniques used in contemporary CTO PCI. Methods & Results: We reviewed patients undergoing CTO PCI at our centre from April 2010 to February 2019. A total of 301 patients were included. The mean age was 69.3 years (±10.3) with 16.6% females and a mean BMI of 28.5 kg/m2 (±5.6). 28.6% of patients had a previous coronary artery bypass graft, with 7% of CTOs being within a stented vessel. The right coronary artery (RCA) was the commonest target vessel, accounting for 53.8% of cases, followed by the left circumflex artery (25.2%) and left anterior descending artery (19.3%). The remainder comprised of vein grafts or a protected left main stem (1.7%). The mean J-CTO score was 1.9, with a median score of 2. The overall procedural success rate was 72.1%. A higher J-CTO score was associated with greater utilisation of the retrograde approach (p < 0.01) although not dissection re-entry approach (p = 0.18). A higher J-CTO score was associated with a lower rate of procedural success (p < 0.0001). In multi-variate analysis, after correcting for age, gender and BMI, the J-CTO score remained predictive of procedural success (p < 0.0001). Conclusions: The J-CTO score remains a valuable tool to predict procedural success in patients undergoing contemporary CTO PCI. Routine calculation of the J-CTO score remains useful to identify challenging cases which may require additional planning or proctoring.