External validation of the PROGRESS‐CTO perforation risk score: Individual patient data pooled analysis of three registries
Year: 2023
Type: article
Abstract: BACKGROUND: Coronary artery perforation is one of the most feared and common complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: To assess the usefulness of the recently developed PROGRESS-CTO (NCT02061436) perforation risk score in independent cohorts. Individual patient-level data pooled analysis of three registries was performed. RESULTS: Of the 4566 patients who underwent CTO PCI at 25 centers, 196 (4.2%) had coronary artery perforation. Patients with perforations were older (69 ± 10 vs. 65 ± 10, p < 0.001), more likely to be women (19% vs. 13%, p = 0.009), more likely to have a history of prior coronary artery bypass graft (34% vs. 20%, p < 0.001), and unfavorable angiographic characteristics such as blunt stump (62% vs. 48%, p < 0.001), proximal cap ambiguity (52% vs. 34%, p < 0.001), and moderate-severe calcification (60% vs. 49%, p = 0.002). Technical success was lower in patients with perforations (73% vs. 88%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO perforation risk model was 0.76 (95% confidence interval [CI], 0.72-0.79), with good calibration (Hosmer-Lemeshow p = 0.97). We found that the CTO PCI perforation risk increased with higher PROGRESS-CTO perforation scores: 0.3% (score 0), 2.3% (score 1), 3.1% (score 2), 5.5% (score 3), 7.5% (score 4), 14.6% (score 5). CONCLUSION: Given the good discriminative performance, calibration, and the ease of calculation, the PROGRESS-CTO perforation score may facilitate assessment of the risk of perforation in patients undergoing CTO PCI.
DOI: 10.1002/ccd.30551
Authors: Bahadir Simsek, Peter Tajti, Mauro Carlino, Soledad Ojeda, Manuel Pan, Stephane Rinfret, Evangelia Vemmou, Spyridon Kostantinis, Ilias Nikolakopoulos, Judit Karacsonyi, Athanasios Rempakos, Joseph A. Dens, Pierfrancesco Agostoni, Khaldoon Alaswad, Michael Megaly, Alexandre Avran, James W. Choi, Farouc A. Jaffer, Darshan Doshi, Dimitri Karmpaliotis, Jaikirshan J. Khatri, Paul Knaapen, Alessio La Manna, James C. Spratt, Masaki Tanabe, Simon Walsh, Olga C. Mastrodemos, Salman Allana, Bavana V. Rangan, Omer Goktekin, Sevket Gorgulu, Paul Poommipanit, Kathleen E. Kearney, William L. Lombardi, J. Aaron Grantham, Kambis Mashayekhi, Emmanouil S. Brilakis, Lorenzo Azzalini
Institutions: Minneapolis Heart Institute Foundation, Gottsegen National Cardiovascular Center, IRCCS Ospedale San Raffaele, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, University of Córdoba, Emory University, Yale University, Ziekenhuis Oost-Limburg, Henry Ford Health, Clinique Pasteur, Texas Health Dallas, Harvard University, Massachusetts General Hospital, Morristown Medical Center, Cleveland Clinic, Amsterdam UMC Location Vrije Universiteit Amsterdam, University of Catania, St George’s University Hospitals NHS Foundation Trust, Nozaki Tokushukai Hospital, Biruni University, University Hospitals of Cleveland, University of Washington, Saint Luke's Hospital, Universitäts-Herzzentrum Freiburg-Bad Krozingen
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4313750707