Association between J-scores and ostial lesions: quantifying the effects of ostial lesions in chronic total occlusion percutaneous interventions

Abstract Aims We aimed to evaluate the influence of ostial lesions on the predicted probability of success in patients undergoing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). Methods 245 patients underwent CTO PCIs at our center, Germany. Of these patients, 197 (80.4%) without an ostial lesion and 48 (19.6%) with an ostial lesion were evaluated. Logistic regression models were used to estimate the interaction effect between the presence of ostial lesions and J-score. Results The ostial lesion group exhibited significantly higher pro-B-type natriuretic peptide levels (1644 pg/ml vs. 963 pg/ml, p=0.034) than the non-ostial lesion group. The final success rate was lower in the ostial lesion group than in the non-ostial lesion group (64.6% vs. 81.7%, p=0.018). The ostial lesion group had higher J-scores than the non-ostial lesion group, indicating more complex lesions (median: 2.5 vs. 2.0, p=0.005). Technical details revealed less antegrade (68.8% vs. 89.8%, p=0.001) and more retrograde access (33.3% vs. 7.6%, p<0.001) in the ostial lesion group than in the non-ostial lesion group. An ordered logistic regression with J-score as an outcome showed a statistically significant association between higher J-scores and ostial lesions (OR, 2.4; p=0.003). Investigating the association between ostial lesion and J-score categories (<3 and ≥3) revealed that ostial lesions were associated with lower success rates, especially in cases with higher J-scores (≥3), although the interaction effect was not statistically significant (p=0.506). Conclusion The presence of ostial CTO is associated with higher lesion complexity and lower technical and procedural success rates. Further studies, based on our retrospective and the previous studies, require the inclusion of the presence of ostial CTO as a factor in the currently used CTO scores to predict the difficulty of CTO procedure.Interaction EffectPredicted Probability