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Outcomes after percutaneous coronary intervention and comparison among scoring systems in predicting procedural success in elderly patients (≥75 years) with chronic total occlusion

Su, Ya-Mina; Pan, Minb; Geng, Hai-Huab; Zhang, Ruia; Qu, Yang-Yanga; Ma, Gen-Shana

doi: 10.1097/MCA.0000000000000765
Original research: PDF Only

Background Evidence-based data on percutaneous coronary intervention in elderly patients with chronic total occlusion (CTO) and comparison among different scoring systems have not been well established.

Patients and methods A total of 246 consecutive patients were stratified into two groups according to the age: elderly group (age≥75 years, n=68) and nonelderly group (age<75 years, n=178). Clinical and angiographic characteristics including the Synergy Between PCI With TAXUS and Cardiac Surgery score, in-hospital major adverse cardiac events, procedural success rates, and predictive capacity of four scoring systems [J-CTO, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO), clinical and lesion-related (CL), and ostial location, Rentrop grade<2, age≥75 years (ORA) scores] were examined.

Results Triple-vessel disease and the Synergy Between PCI With TAXUS and Cardiac Surgery score in the elderly group were significantly higher than those in the nonelderly group (73.53 vs. 53.93%, P=0.005; 31.39±7.68 vs. 27.85±7.16, P=0.001, respectively). The in-hospital major adverse cardiac event rates, vascular access complication rates, and major bleeding rates were similar between the elderly and the nonelderly group (2.94 vs. 2.25%, P=0.669; 1.47 vs. 0.56%, P=0.477; 2.94 vs. 1.12%, P=0.306, respectively). By contrast, the procedural success rate was statistically lower in the elderly group than that in the nonelderly group (73.53 vs. 84.83%, P=0.040). All the four scoring systems showed a moderate predictive capacity [area under the curve (AUC) for J-CTO score: 0.806, P<0.0001; AUC for PROGRESS CTO score: 0.727, P<0.0001; AUC for CL score: 0.800, P<0.0001; AUC for ORA score: 0.672, P<0.0001, respectively]. Compared with the ORA score, the J-CTO score, and the CL score showed a significant advantage in predicting procedural success among overall patients ([INCREMENT]AUC=0.134, P=0.0122; [INCREMENT]AUC=0.128, P=0.0233, respectively).

Conclusion Despite the lower procedural success rate, percutaneous coronary intervention in elderly patients with CTO is feasible and safe. J-CTO, PROGRESS, ORA, and CL scoring systems have moderate discriminatory capacity.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

aDepartment of Cardiology, School of Medicine, Southeast University, Nanjing

bDepartment of Cardiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China

Correspondence to Gen-Shan Ma, MD, PhD, Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, Jiangsu, People’s Republic of China Tel: +86 025 8326 2391; fax: +86 025 8326 2395; e-mail:

Received December 30, 2018

Received in revised form April 20, 2019

Accepted May 6, 2019

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