TY - JOUR
T1 - Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention
AU - Karacsonyi, Judit
AU - Stanberry, Larissa
AU - Simsek, Bahadir
AU - Kostantinis, Spyridon
AU - Allana, Salman S.
AU - Rempakos, Athanasios
AU - Okeson, Brynn
AU - Alaswad, Khaldoon
AU - Basir, Mir B.
AU - Jaffer, Farouc
AU - Poommipanit, Paul
AU - Khatri, Jaikirshan
AU - Patel, Mitul
AU - Mahmud, Ehtisham
AU - Sheikh, Abdul
AU - Wollmuth, Jason R.
AU - Yeh, Robert W.
AU - Chandwaney, Raj H.
AU - ElGuindy, Ahmed M.
AU - Abi Rafeh, Nidal
AU - Schimmel, Daniel R.
AU - Benzuly, Keith
AU - Burke, M. Nicholas
AU - Rangan, Bavana V.
AU - Mastrodemos, Olga C.
AU - Sandoval, Yader
AU - Ungi, Imre
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.amjcard.2023.06.051
DO - 10.1016/j.amjcard.2023.06.051
M3 - Article
C2 - 37429059
AN - SCOPUS:85164335300
SN - 0002-9149
VL - 202
SP - 111
EP - 118
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -