Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score

Alfredo Ruggero Galassi, Thierry Lefevre, Evald Christiansen, Nicolas Boudou, Tim Clayton, Victoria Martin-Yuste, Bernward Lauer, James Spratt, Alfredo Galassi, Rajiv Rampat, Javier Escaned, Alexandre Avran, Marcus Meyer-Gessner, Claudius Ho, Mashayekhi Kambis, Zsolt Szijgyarto, Roberto Garbo, Andrejs Erglis, Simon Elhadad, Lesciak BryniarskiOmer Goktekin, George Sianos, Alexander Bufe, Yves Louvard, Anthony Gershlick, Horst Sievert, Leif Thuesen, Carlo Di Mario, Heinz-Joachim Buettner, Gerald S. Werner, Nicolaus Reifart, David Hildick-Smith

Risultato della ricerca: Articlepeer review

24 Citazioni (Scopus)


Objectives: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. Background: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. Methods: The study 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) datasets were created to develop a risk score for predicting technical failure. Results: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (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. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft 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) datasets. Conclusions: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome.
Lingua originaleEnglish
pagine (da-a)335-342
Numero di pagine8
RivistaJACC: Cardiovascular Interventions
Stato di pubblicazionePublished - 2019

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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