Prognostic value of chronic total occlusion complexity scoring systems beyond procedural planning: a comparative analysis of five contemporary scores in patients undergoing chronic total occlusion percutaneous coronary intervention
- 1Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey
Abstract
Introduction: Chronic total occlusion (CTO) complexity scores were developed to predict procedural difficulty during CTO percutaneous coronary intervention (CTO-PCI). Their value for predicting long-term clinical outcomes remains uncertain.
Aim: We investigated the association between commonly used CTO complexity scores and adverse outcomes after CTO-PCI and compared their prognostic performance.
Material and methods: This retrospective single-center cohort study included 149 consecutive patients undergoing CTO-PCI. Five CTO complexity scores (J-CTO, RECHARGE, PROGRESS-CTO, CL, and CASTLE) were calculated. The primary endpoint was a composite of all-cause mortality or urgent coronary revascularization. Multivariable Cox regression, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis were performed.
Results: During a mean follow-up of 17.1 ±10.6 months, the composite endpoint occurred in 30 (20.1%) patients. After adjustment for age, left ventricular ejection fraction, serum creatinine, and albumin, all five CTO scores remained independently associated with the composite outcome. The J-CTO score showed the strongest association (adjusted HR = 2.18, 95% CI: 1.38–3.45; p = 0.001). The CASTLE score had the highest observed ROC-AUC (0.726, p < 0.001), although its discriminatory performance did not differ significantly from that of the J-CTO score. Harrell’s C-index also demonstrated comparable discrimination between the CASTLE and J-CTO scores (both C-index 0.697), indicating modest-to-moderate discriminatory ability. Patients with J-CTO ≥ 2 or CASTLE ≥ 2 had significantly worse event-free survival (log-rank p = 0.013 and p = 0.004, respectively).
Conclusions: CTO complexity scores were independently associated with long-term adverse outcomes after CTO-PCI and may have prognostic relevance in addition to their established role in procedural planning. These findings should be confirmed in larger prospective studies.
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BibTeX
@article{teber2026prognostic,
title = {{Prognostic value of chronic total occlusion complexity scoring systems beyond procedural planning: a comparative analysis of five contemporary scores in patients undergoing chronic total occlusion percutaneous coronary intervention}},
author = {Mehmet K. Teber and Mehmet Z. Aydın},
journal = {Postepy w kardiologii interwencyjnej = Advances in interventional cardiology},
year = {2026},
month = sep,
doi = {10.5114/aic.2026.164557},
url = {https://europepmc.org/article/PMC/PMC13721082},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Prognostic value of chronic total occlusion complexity scoring systems beyond procedural planning: a comparative analysis of five contemporary scores in patients undergoing chronic total occlusion percutaneous coronary intervention
AU - Mehmet K. Teber
AU - Mehmet Z. Aydın
PY - 2026
DA - 2026/09/01
JO - Postepy w kardiologii interwencyjnej = Advances in interventional cardiology
DO - 10.5114/aic.2026.164557
UR - https://europepmc.org/article/PMC/PMC13721082
AB - Introduction: Chronic total occlusion (CTO) complexity scores were developed to predict procedural difficulty during CTO percutaneous coronary intervention (CTO-PCI). Their value for predicting long-term clinical outcomes remains uncertain. Aim: We investigated the association between commonly used CTO complexity scores and adverse outcomes after CTO-PCI and compared their prognostic performance. Material and methods: This retrospective single-center cohort study included 149 consecutive patients undergoing CTO-PCI. Five CTO complexity scores (J-CTO, RECHARGE, PROGRESS-CTO, CL, and CASTLE) were calculated. The primary endpoint was a composite of all-cause mortality or urgent coronary revascularization. Multivariable Cox regression, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis were performed. Results: During a mean follow-up of 17.1 ±10.6 months, the composite endpoint occurred in 30 (20.1%) patients. After adjustment for age, left ventricular ejection fraction, serum creatinine, and albumin, all five CTO scores remained independently associated with the composite outcome. The J-CTO score showed the strongest association (adjusted HR = 2.18, 95% CI: 1.38–3.45; p = 0.001). The CASTLE score had the highest observed ROC-AUC (0.726, p < 0.001), although its discriminatory performance did not differ significantly from that of the J-CTO score. Harrell’s C-index also demonstrated comparable discrimination between the CASTLE and J-CTO scores (both C-index 0.697), indicating modest-to-moderate discriminatory ability. Patients with J-CTO ≥ 2 or CASTLE ≥ 2 had significantly worse event-free survival (log-rank p = 0.013 and p = 0.004, respectively). Conclusions: CTO complexity scores were independently associated with long-term adverse outcomes after CTO-PCI and may have prognostic relevance in addition to their established role in procedural planning. These findings should be confirmed in larger prospective studies.
SN - 1734-9338
SN - 1897-4295
ER -