Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention
Author:
Karacsonyi JuditORCID, Stanberry LarissaORCID, Simsek BahadirORCID, Kostantinis SpyridonORCID, Allana Salman S., Rempakos Athanasios, Okeson BrynnORCID, Alaswad KhaldoonORCID, Basir Mir B.ORCID, Jaffer FaroucORCID, Poommipanit PaulORCID, Khatri JaikirshanORCID, Patel Mitul, Mahmud Ehtisham, Sheikh Abdul, Wollmuth Jason R., Yeh Robert WORCID, Chandwaney Raj H., ElGuindy Ahmed MORCID, AbiRafeh Nidal, Schimmel Daniel R.ORCID, Benzuly KeithORCID, Burke M. NicholasORCID, Rangan Bavana V., Mastrodemos Olga C., Sandoval YaderORCID, Ungi Imre, Brilakis Emmanouil S.ORCID
Abstract
ABSTRACTBackgroundEstimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).MethodsWe analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample as well as on 2411 out-of-sample procedures who did not require urgent MCS.ResultsUrgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63, 77] vs. 66 [58, 73] years, p=0.003) compared with those who did not require urgent MCS. Technical (68% vs. 87%, p<0.001) and procedural successes (40% vs. 85%, p<0.001) were lower in the urgent MCS group compared with no urgent MCS cases. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with AUC (95%CI) of 0.79 (0.73, 0.86) and specificity and sensitivity of 86% and 52%, respectively. On the out-of-sample set, the specificity of the model was 87%.ConclusionThe PROGRESS CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.What Is Known?Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).What the Study Adds?We developed a risk model for urgent MCS use during CTO PCI using retrograde crossing strategy, left ventricular ejection fraction, and lesion length.Use of the PROGRESS CTO urgent MCS score may facilitate patient selection for prophylactic hemodynamic support optimizing the risk benefit ratio of the procedure.
Publisher
Cold Spring Harbor Laboratory
Reference21 articles.
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