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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
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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.

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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: magenshan@hotmail.com

Received December 30, 2018

Received in revised form April 20, 2019

Accepted May 6, 2019

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