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A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score.

  • Namazi, Mohammad Hasan1
  • Serati, Ali Reza1
  • Vakili, Hosein1
  • Safi, Morteza1
  • Parsa, Saeed Ali Pour1
  • Saadat, Habibollah1
  • Taherkhani, Maryam1
  • Emami, Sepideh1
  • Pedari, Shamseddin1
  • Vatanparast, Masoomeh1
  • Movahed, Mohammad Reza2, 3
  • 1 Cardiovascular Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , (Iran)
  • 2 CareMore Health Care, Tucson, Arizona.
  • 3 Department of Medicine, University of Arizona, Tucson, Arizona.
Published Article
The International journal of angiology : official publication of the International College of Angiology, Inc
Publication Date
Jun 01, 2017
DOI: 10.1055/s-0036-1593394
PMID: 28566934


Total occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach. This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach. A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97-23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95-17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46-7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28-6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08-6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03-6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate. Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0-8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.

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