Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Judit Karacsonyi, Larissa Stanberry, Bahadir Simsek, Spyridon Kostantinis, Salman S. Allana, Athanasios Rempakos, Brynn Okeson, Khaldoon Alaswad, Mir B. Basir, Farouc Jaffer, Paul Poommipanit, Jaikirshan Khatri, Mitul Patel, Ehtisham Mahmud, Abdul Sheikh, Jason R. Wollmuth, Robert W. Yeh, Raj H. Chandwaney, Ahmed M. ElGuindy, Nidal Abi RafehDaniel R. Schimmel, Keith Benzuly, M. Nicholas Burke, Bavana V. Rangan, Olga C. Mastrodemos, Yader Sandoval, Imre Ungi, Emmanouil S. Brilakis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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). We 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 and on 2,411 out-of-sample procedures that did not require urgent MCS. Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63 to 77] vs 66 [58 to 73] years, p = 0.003) compared with those who did not require urgent MCS. Technical (68% vs 87%, p <0.001) and procedural success (40% vs 85%, p <0.001) was lower in the urgent MCS group compared with cases that did not require urgent MCS. 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 the area under the curve (95% confidence interval) of 0.79 (0.73 to 0.86) and specificity and sensitivity of 86% and 52%, respectively. In the out-of-sample set, the specificity of the model was 87%. The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.

Original languageEnglish (US)
Pages (from-to)111-118
Number of pages8
JournalAmerican Journal of Cardiology
Volume202
DOIs
StatePublished - Sep 1 2023

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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