Disclosures/Conflicts of Interest: Jo Dens received grants from TopMedical (Distributor of Asahi Intecc co. materials), Boston Scientific, Vascular Solutions, and Orbus Neich for teaching courses and proctoring. Simon Walsh and James C Spratt are consultants for Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Simon Walsh received research funding from Abbott Vascular, Boston Scientific, and Nitiloop. Paul Knaapen and Erwan Bressollette received honoraria from Boston Scientific for proctoring. Pierfrancesco Agostoni received institutional honoraria from Aquilant, Meril, Neovasc, Genae, and Angiodynamics. Alexandre Avran received grants form Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring. John Irving is a proctor for Boston Scientific and Vascular Perspectives. Elliot Smith is proctor for Boston Scientific and receives honoraria from Vascular Solutions, Abbott Vascular, and Vascular Perspectives. Alan J. Bagnall received proctor and speaker fees from Abbott Vascular and Astra Zeneca. Benjamin Faurie is proctor for Boston Scientific and consultant for CORDIS. Paul Kelly is a member of the advisory board of Boston Scientific and Abbott Vascular. For the remaining authors, nothing was declared.

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Abstract

Objectives

This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels.

Background

Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators.

Methods

Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores.

Results

Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores.

Conclusions

The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators. © 2017 Wiley Periodicals, Inc.

REFERENCES

1 Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Hinohara T, Tanaka H, Mitsudo K, and Investigators JCR. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Intervent 2011; 4: 213–221.
10.1016/j.jcin.2010.09.024
PubMed Web of Science® Google Scholar
2 Brilakis ES, Grantham JA, Rinfret S, Wyman RM, Burke MN, Karmpaliotis D, Lembo N, Pershad A, Kandzari DE, Buller CE, DeMartini T, Lombardi WL, Thompson CA. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Intervent 2012; 5: 367–379.
10.1016/j.jcin.2012.02.006
PubMed Web of Science® Google Scholar
3 Syrseloudis D, Secco GG, Barrero EA, Lindsay AC, Ghione M, Kilickesmez K, Foin N, Martos R, Di Mario C. Increase in J-CTO lesion complexity score explains the disparity between recanalisation success and evolution of chronic total occlusion strategies: insights from a single-centre 10-year experience. Heart 2013; 99: 474–479.
10.1136/heartjnl-2012-303205
PubMed Web of Science® Google Scholar
4 Maeremans J, Selleslagh P, Di Serafino L, Barbato E, Dens J. Impact of negative lesion characteristics of chronic total occlusions on procedural outcome and strategy. Acta Cardiol 2013; 68: 455–461.
Google Scholar
5 Tanaka H, Morino Y, Abe M, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Morimoto T, Hinohara T, Fujii T, Mitsudo K. Impact of J-CTO score on procedural outcome and target lesion revascularisation after percutaneous coronary intervention for chronic total occlusion: a substudy of the J-CTO Registry (Multicentre CTO Registry in Japan). EuroIntervention 2016; 11: 981–988.
10.4244/EIJV11I9A202
PubMed Web of Science® Google Scholar
6 Karatasakis A, Danek B, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel MP, Bahadorani JN, Brilakis ES. Impact of proximal cap ambiguity on outcomes of chronic total occlusion percutaneous coronary intervention: Insights from a multicenter US registry. J Invasive Cardiol 2016; 28: 391–396.
PubMed Web of Science® Google Scholar
7 Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani JN, Lombardi WL, Wyman RM, Grantham JA, Kandzari DE, Lembo NJ, Doing AH, Toma C, Moses JW, Kirtane AJ, Parikh MA, Ali ZA, Garcia S, Kalsaria P, Karacsonyi J, Alame AJ, Thompson CA, Banerjee S, Brilakis ES. Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention. Int J Cardiol 2016; 224: 50–56.
10.1016/j.ijcard.2016.08.317
PubMed Web of Science® Google Scholar
8 Galassi AR, Boukhris M, Azzarelli S, Castaing M, Marza F, Tomasello SD. Percutaneous coronary revascularization for chronic total occlusions: A novel predictive score of technical failure using advanced technologies. JACC Cardiovasc Intervent 2016; 9: 911–922.
10.1016/j.jcin.2016.01.036
PubMed Web of Science® Google Scholar
9 Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, Alaswad K, Lombardi W, Grantham JA, Moses J, Christakopoulos G, Tarar MNJ, Rangan BV, Lembo N, Garcia S, Cipher D, Thompson CA, Banerjee S, Brilakis ES. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score. JACC Cardiovasc Intervent 2016; 9: 1–9.
10.1016/j.jcin.2015.09.022
PubMed Web of Science® Google Scholar
10 Alessandrino G, Chevalier B, Lefèvre T, Sanguineti F, Garot P, Unterseeh T, Hovasse T, Morice M-C, Louvard Y. A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC Cardiovasc Intervent 2015; 8: 1540–1548.
10.1016/j.jcin.2015.07.009
PubMed Web of Science® Google Scholar
11 Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC. Hybrid approach improves success of chronic total occlusion angioplasty. Heart 2016.
Google Scholar
12 Maeremans J, Walsh S, Knaapen P, Spratt JC, Avran A, Hanratty CG, Faurie B, Agostoni P, Bressollette E, Kayaert P, Bagnall AJ, Egred M, Smith D, Chase A, McEntegart MB, Smith WHT, Harcombe A, Kelly P, Irving J, Smith EJ, Strange JW, Dens J. The hybrid algorithm for treating chronic total occlusions in Europe: The RECHARGE registry. J Am Coll Cardiol 2016; 68: 1958–1970.
10.1016/j.jacc.2016.08.034
PubMed Web of Science® Google Scholar
13 Abbas AE, Brewington SD, Dixon SR, Boura J, Grines CL, O'Neill WW. Success, safety, and mechanisms of failure of percutaneous coronary intervention for occlusive non–drug-eluting in-stent restenosis versus native artery total occlusion. Am J Cardiol 2005; 95: 1462–1466.
10.1016/j.amjcard.2005.01.098
PubMed Web of Science® Google Scholar
14 Karacsonyi J, Karatasakis A, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman MR, Lombardi WL, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh MA, Green P, Finn M, Garcia S, Doing A, Patel M, Bahadorani J, Martinez Parachini JR, Resendes E, Rangan BV, Ungi I, Thompson CA, Banerjee S, Brilakis ES. Effect of previous failure on subsequent procedural outcomes of chronic total occlusion percutaneous coronary intervention (from a Contemporary Multicenter Registry). Am J Cardiol 2016; 117: 1267–1271.
10.1016/j.amjcard.2016.01.021
PubMed Web of Science® Google Scholar
15 Wilson WM, Walsh S, Hanratty C, Strange J, Hill J, Sapontis J, Spratt JC. A novel approach to the management of occlusive in-stent restenosis (ISR). EuroIntervention 2014; 9: 1285–1293.
10.4244/EIJV9I11A218
PubMed Web of Science® Google Scholar
16 Abdel-karim AR, Lombardi WB, Banerjee S, Brilakis ES. Contemporary outcomes of percutaneous intervention in chronic total coronary occlusions due to in-stent restenosis. Cardiovasc Revascular Med 2011; 12: 170–176.
10.1016/j.carrev.2010.08.002
PubMed Google Scholar
17 McEntegart MB, Badar AA, Ahmad FA, Shaukat A, MacPherson M, Irving J, Strange J, Bagnall AJ, Hanratty CG, Walsh SJ, Werner GS, Spratt JC. The collateral circulation of coronary chronic total occlusions. EuroIntervention 2016; 11: e1596–e1603.
10.4244/EIJV11I14A310
PubMed Web of Science® Google Scholar
18 Christopoulos G, Menon RV, Karmpaliotis D, Alaswad K, Lombardi W, Grantham JA, Michael TT, Patel VG, Rangan BV, Kotsia AP, Lembo N, Kandzari DE, Lee J, Kalynych A, Carlson H, Garcia S, Banerjee S, Thompson CA, Brilakis ES. Application of the “Hybrid Approach” to chronic total occlusions in patients with previous coronary artery bypass graft surgery (from a Contemporary Multicenter US Registry). Am J Cardiol 2014; 113: 1990–1994.
10.1016/j.amjcard.2014.03.039
PubMed Web of Science® Google Scholar
19 Michael TT, Karmpaliotis D, Brilakis ES, Abdullah SM, Kirkland BL, Mishoe KL, Lembo N, Kalynych A, Carlson H, Banerjee S, Lombardi W, Kandzari DE. Impact of prior coronary artery bypass graft surgery on chronic total occlusion revascularisation: insights from a multicentre US registry. Heart 2013; 99: 1515–1518.
10.1136/heartjnl-2013-303763
PubMed Web of Science® Google Scholar
20 Teramoto T, Tsuchikane E, Matsuo H, Suzuki Y, Ito T, Ito T, Habara M, Nasu K, Kimura M, Kinoshita Y, Terashima M, Asakura Y, Matsubara T, Suzuki T. Initial success rate of percutaneous coronary intervention for chronic total occlusion in a native coronary artery is decreased in patients who underwent previous coronary artery bypass graft surgery. JACC Cardiovasc Intervent 2014; 7: 39–46.
10.1016/j.jcin.2013.08.012
PubMed Web of Science® Google Scholar
21 Nombela-Franco L, Urena M, Jerez-Valero M, Nguyen CM, Ribeiro HB, Bataille Y, Rodés-Cabau J, Rinfret S. Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort. Circ Cardiovasc Intervent 2013; 6: 635–643.
10.1161/CIRCINTERVENTIONS.113.000447
PubMed Web of Science® Google Scholar
22 Christopoulos G, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi W, Grantham JA, Yeh RW, Jaffer FA, Cipher DJ, Rangan BV, Christakopoulos GE, Kypreos MA, Lembo N, Kandzari D, Garcia S, Thompson CA, Banerjee S, Brilakis ES. Clinical utility of the Japan-chronic total occlusion score in coronary chronic total occlusion interventions: Results from a multicenter registry. Circ Cardiovasc Intervent 2015; 8.
Google Scholar

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Volume91, Issue2

February 1, 2018

Pages 192-202

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Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score

Abstract

Objectives

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

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Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score

Abstract

Objectives

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

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