Stumpless lesion improves the value of J-CTO score in predicting the antegrade procedure outcome of chronic total occlusion percutaneous coronary intervention

Background Percutaneous coronary intervention (PCI) of coronary chronic total occlusion (CTO) is one of the most challenging procedures of interventional cardiology. Debate continues with regard to the predictors that influence the antegrade procedure outcome. Methods The CTO PCIs were prospectively registered from May 1, 2012 to August 22, 2017 in a single center. Variables of patients' characteristics, CTO morphology, PCI strategy, procedure materials and outcomes were recorded. Multivariable logistic regression model was adopted to identify predictors of procedure outcome. Results A total of 193 CTO PCIs were consecutively included, and 187 antegrade PCIs were finally analyzed. The antegrade technical and procedure success rates were both 67.91%. Multivariable logistic regression indicated that stumpless lesion (OR: 2.813; 95% CI: 1.120–7.062, p = 0.028) and occlusion length ≥ 20 mm (OR: 2.196; 95% CI: 1.087–4.437, P = 0.028) independently predicted the procedure outcome. The area under the receiver-operator characteristic (ROC) curve for discriminating failed CTO PCI was 0.621 (95% CI: 0.534–0.708, p = 0.008) for Japanese multicenter CTO registry (J-CTO) score, which significantly increased to 0.673 (95% CI: 0.592–0.755, p = 0.000) after modifying stumpless lesion score from 1 to 2 points. Conclusions Stumpless lesion and occlusion length ≥ 20 mm independently predict the antegrade CTO procedure failure. Scoring 2 points to stumpless lesion improves the value of J-CTO score in predicting the procedure outcome.