Validation and comparison of five chronic total occlusion scores to predict difficulty of percutaneous coronary intervention

OBJECTIVE: The value of preprocedural coronary computed tomography angiography (CCTA) assessment in chronic total occlusion (CTO)remains under debatable This study aimed to evaluate the predictive performance of five CTO scoring systems for time-efficient guidewire (GW) crossing. MATERIALS AND METHODS: A total of 220 patients with 220 CTO lesions who underwent CCTA prior to invasive coronary angiography (ICA) with CTO Percutaneous coronary intervention (PCI) in three centers were retrospectively enrolled. Procedural difficulty was classified using five scoring systems: the CT Registry of CTO Revascularization (CT-RECTOR), Korean Multicenter CTO CT Registry (KCCT), Multicenter CTO Registry of Japan (J-CTO), Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS), the clinical and lesion-related score (CL-score). The primary endpoint was successful GW crossing within 30 min. Receiver operating characteristic (ROC) curves and net reclassification improvement (NRI) were used to compare the predictive performance of the scores. RESULTS: GW crossing within 30 min and final success were achieved in 55% and 81% of cases, respectively. The area under the ROC curve for predicting successful GW crossing within 30 min was 0.609 for PROGRESS,0.783 for KCCT,0.731 for CL-score,0.853 for CT-RECTOR and 0.774 for J-CTO. The NRI for CT-RECTOR was significantly higher than for the other models (vs. PROGRESS: 0.70, p < 0.001; vs. J-CTO: 0.32, p < 0.001; vs. CL-score: 0.52, p < 0.001; vs. KCCT: 0.35, p < 0.001). CONCLUSIONS: CT-RECTOR and KCCT scoring systems demonstrated superior performance in predicting time-efficient GW crossing .CCTA may enhance anatomical assessment and support procedural planning and strategy optimization.