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EuroCTO (CASTLE) Score Validation
Study Questions:
What is the utility of a contemporary scoring system to predict the outcome of chronic total occlusion (CTO) coronary angioplasty?
Methods:
The investigators analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) data sets were created to develop a risk score for predicting technical failure. Using multiple imputed data to account for missing values, patients’ demographic data and medical history variables were first entered into the logistic regression model. Baseline measurements and lesion characteristics were then added to the model and evaluated using the preset p value of < 0.01 for variable retention. In the final stage, variables initially excluded were sequentially re-entered into the model and were re-assessed using the preset inclusion criteria.
Results:
There were 14,882 patients in the derivation data set (with 2,356 [15.5%] failures) and 5,745 in the validation data set (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. The authors identified six predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass grafting history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC, 0.66) and validation (AUC, 0.68) data sets.
Conclusions:
The authors concluded that EuroCTO (CASTLE) score offers a useful tool for predicting procedural outcome.
Perspective:
This study reports that the EuroCTO (CASTLE) prediction score, a multicenter-derived scoring system to predict technical failure in the percutaneous treatment of CTO, has a greater discriminative capacity compared with the widely used J-CTO score. Previous CABG, over 70 years of age, a blunt stump, severe tortuosity, length of the occlusion, and extent of calcification were strongly associated with unsuccessful CTO-PCI. Additional prospective studies are indicated to assess and validate the predictive ability of this model.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias
Keywords: Angioplasty, Calcification, Physiologic, Coronary Artery Bypass, Coronary Occlusion, Geriatrics, Myocardial Ischemia, Percutaneous Coronary Intervention, Secondary Prevention
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