Abstract
Successful revascularization of chronic total occlusion (CTO) by percutaneous coronary intervention (PCI) is associated with reduced major adverse cardiovascular events (MACEs) compared with CTO PCI failure. The developments of new strategies and new devices have improved the success rate of CTO PCI. However, the complexity of CTO lesions, clinical characteristics of patients and operator experience highly determine the successful revascularization. Using search items, “chronic total occluion”, “percutaneous coronary intervention”, “scoring systems”, “predictablity”. We searched Pubmed, ScienceDirect, Web of Science, Cochrane Library, and CNKI. We found six clinically used scoring systems from 2011 to 2018. They included J-CTO score, CT-RECTOR score, CL score, PROGRESS CTO score, ORA score, and Ellis score. All parameters of each scoring systems have been systematically reviewed. The patients with higher score have found to have adecreased probability of CTO recanalization. Ellis score that mainly focused on ambiguous proximal cap and hybrid approach seems to provide better predictability in deciding procedure strategy.
Highlights
We found six clinically used scoring systems from 2011 to 2018
Sharma et al and Scott et al emphasized the need of proctorship to improve chronic total occlusion (CTO) percutaneous coronary intervention (PCI) skills, and found useful in patients with J-CTO score ≥ 2 with success rate improving from 49.5% to 70.7% [16] [17]
The PROGRESS CTO scoring system does not include prior CTO PCI failure, which according to Christopoulos et al, highly dependent on experience and expertise of operator who performs the procedure
Summary
Success rate of treating these occlusions is only 65% - 70% even in experienced hands [2], significant clinical benefits to the patients has been associated after successful CTO recanalization [3]. These benefits include improved symptoms of angina and dyspnoea, decrease need for anti-anginal medications, improved left ventricular function, decreased need for CABG, and improved survival [4] [5]. Various scoring systems were developed (i.e. J-CTO score, CT-RECTOR score, CL score, PROGRESS CTO score, ORA score, and Ellis score) (Table 1) to predict the probability of successful intervention and a better selection of both patient and operator. We discuss these scoring systems and compare their validity and efficacy in predicting successful revascularization in CTO patient
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