Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score

Joren Maeremans, James C. Spratt, Paul Knaapen, Simon Walsh, Pierfrancesco Agostoni, William Wilson, Alexandre Avran, Benjamin Faurie, Erwan Bressollette, Peter Kayaert, Alan J. Bagnall, Dave Smith, Margaret B. McEntegart, William H. T. Smith, Paul Kelly, John Irving, Elliot J. Smith, Julian W. Strange, Jo Dens (Lead / Corresponding author)

    Research output: Contribution to journalArticle

    11 Citations (Scopus)

    Abstract

    Objectives: This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels.

    Background: Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators.

    Methods: Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores.

    Results: Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores.

    Conclusions: The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators.

    Original languageEnglish
    Pages (from-to)192-202
    Number of pages11
    JournalCatheterization and Cardiovascular Interventions
    Volume91
    Issue number2
    Early online date4 May 2017
    DOIs
    Publication statusPublished - 1 Feb 2018

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    Area Under Curve
    Percutaneous Coronary Intervention
    Belgium
    Netherlands
    France
    Registries
    Therapeutics
    Multivariate Analysis
    Transplants
    United Kingdom

    Keywords

    • Journal article
    • Coronary artery disease
    • Chronic total occlusion
    • Percutaneous coronary intervention
    • Atherosclerosis
    • atherosclerosis
    • coronary artery disease
    • percutaneous coronary intervention
    • chronic total occlusion

    Cite this

    Maeremans, Joren ; Spratt, James C. ; Knaapen, Paul ; Walsh, Simon ; Agostoni, Pierfrancesco ; Wilson, William ; Avran, Alexandre ; Faurie, Benjamin ; Bressollette, Erwan ; Kayaert, Peter ; Bagnall, Alan J. ; Smith, Dave ; McEntegart, Margaret B. ; Smith, William H. T. ; Kelly, Paul ; Irving, John ; Smith, Elliot J. ; Strange, Julian W. ; Dens, Jo. / Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment : The RECHARGE score. In: Catheterization and Cardiovascular Interventions. 2018 ; Vol. 91, No. 2. pp. 192-202.
    @article{d1003b7da50641b7b174495566c12f65,
    title = "Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score",
    abstract = "Objectives: This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels.Background: Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators.Methods: Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores.Results: Technical success in the derivation and validation sets was 83{\%} and 85{\%}, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores.Conclusions: The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators.",
    keywords = "Journal article, Coronary artery disease , Chronic total occlusion , Percutaneous coronary intervention , Atherosclerosis, atherosclerosis, coronary artery disease, percutaneous coronary intervention, chronic total occlusion",
    author = "Joren Maeremans and Spratt, {James C.} and Paul Knaapen and Simon Walsh and Pierfrancesco Agostoni and William Wilson and Alexandre Avran and Benjamin Faurie and Erwan Bressollette and Peter Kayaert and Bagnall, {Alan J.} and Dave Smith and McEntegart, {Margaret B.} and Smith, {William H. T.} and Paul Kelly and John Irving and Smith, {Elliot J.} and Strange, {Julian W.} and Jo Dens",
    note = "Contract grant sponsor: Boston Scientific (Marlborough, USA). Contract grant sponsor: Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.",
    year = "2018",
    month = "2",
    day = "1",
    doi = "10.1002/ccd.27092",
    language = "English",
    volume = "91",
    pages = "192--202",
    journal = "Catheterization and Cardiovascular Interventions",
    issn = "1522-1946",
    publisher = "Wiley",
    number = "2",

    }

    Maeremans, J, Spratt, JC, Knaapen, P, Walsh, S, Agostoni, P, Wilson, W, Avran, A, Faurie, B, Bressollette, E, Kayaert, P, Bagnall, AJ, Smith, D, McEntegart, MB, Smith, WHT, Kelly, P, Irving, J, Smith, EJ, Strange, JW & Dens, J 2018, 'Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score', Catheterization and Cardiovascular Interventions, vol. 91, no. 2, pp. 192-202. https://doi.org/10.1002/ccd.27092

    Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment : The RECHARGE score. / Maeremans, Joren; Spratt, James C.; Knaapen, Paul; Walsh, Simon; Agostoni, Pierfrancesco; Wilson, William; Avran, Alexandre; Faurie, Benjamin; Bressollette, Erwan; Kayaert, Peter; Bagnall, Alan J.; Smith, Dave; McEntegart, Margaret B.; Smith, William H. T.; Kelly, Paul; Irving, John; Smith, Elliot J.; Strange, Julian W.; Dens, Jo (Lead / Corresponding author).

    In: Catheterization and Cardiovascular Interventions, Vol. 91, No. 2, 01.02.2018, p. 192-202.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment

    T2 - The RECHARGE score

    AU - Maeremans, Joren

    AU - Spratt, James C.

    AU - Knaapen, Paul

    AU - Walsh, Simon

    AU - Agostoni, Pierfrancesco

    AU - Wilson, William

    AU - Avran, Alexandre

    AU - Faurie, Benjamin

    AU - Bressollette, Erwan

    AU - Kayaert, Peter

    AU - Bagnall, Alan J.

    AU - Smith, Dave

    AU - McEntegart, Margaret B.

    AU - Smith, William H. T.

    AU - Kelly, Paul

    AU - Irving, John

    AU - Smith, Elliot J.

    AU - Strange, Julian W.

    AU - Dens, Jo

    N1 - Contract grant sponsor: Boston Scientific (Marlborough, USA). Contract grant sponsor: Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.

    PY - 2018/2/1

    Y1 - 2018/2/1

    N2 - Objectives: This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels.Background: Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators.Methods: Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores.Results: Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores.Conclusions: The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators.

    AB - Objectives: This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels.Background: Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators.Methods: Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores.Results: Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores.Conclusions: The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators.

    KW - Journal article

    KW - Coronary artery disease

    KW - Chronic total occlusion

    KW - Percutaneous coronary intervention

    KW - Atherosclerosis

    KW - atherosclerosis

    KW - coronary artery disease

    KW - percutaneous coronary intervention

    KW - chronic total occlusion

    U2 - 10.1002/ccd.27092

    DO - 10.1002/ccd.27092

    M3 - Article

    C2 - 28471074

    VL - 91

    SP - 192

    EP - 202

    JO - Catheterization and Cardiovascular Interventions

    JF - Catheterization and Cardiovascular Interventions

    SN - 1522-1946

    IS - 2

    ER -