[2022/11/3]The J-Calc-CTO score, which uses the degree and distribution of calcification assessed by CT angiography as parameters, had better predictive power than the original J-CTO score for wire passage at 30 minutes in CTO-PCI, as reported by Dr. Yohsuke Honda and his colleagues at Saiseikai Yokohama City Eastern Hospital in the October 1 issue of Catheterization & Cardiovascular Interventions.
Predictive ability of the J-Calc-CTO score to pass a guidewire into a CTO lesion within 30 minutes
Dr. Honda and colleagues randomly divided 137 patients (141 CTO lesions) who underwent CT angiography before CTO-PCI between October 2016 and October 2021 into a derivation cohort (94 patients) and a validation cohort (47 patients) and created a J-Calc-CTO score from calcification parameters related to wire passage at 30 minutes obtained in the derivation cohort and examined its accuracy in comparison with the original J-CTO score.
The success rate of the procedure was 96%, with 29% achieving wire passage in 30 minutes during the procedure. The parameters evaluated by CT angiography included high calcification (OR 4.63 [95%CI 1.24-22.2] p=0.04), defined as a calcification index (calcification volume divided by the length of the occlusion site) >12 and central lumen calcification (OR 7.25 [95%CI 1.48-32.1] p=0.02) were independently associated with wire passage at 30 min.
The J-Calc-CTO score was created with these two parameters as one point instead of "calcification" in the original J-CTO score. The J-Calc-CTO score showed higher predictive power for wire passing at 30 minutes in the derivation cohort (c-statistics 0.836 vs 0.670: p>0.01) and in the validation cohort (c-statistics 0.879 vs 0.767: p>0.01) compared to the J-CTO score.
Dr. Honda and colleagues summarize, "The extent and distribution of calcification identified on CT angiography improved the predictive ability of the original J-CTO score with respect to wire passage at 30 minutes."
Honda Y, et al. Catheter Cardiovasc Interv. 2022; 100: 560-567
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