ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2023
Development and validation of a scoring system for predicting clinical coronary artery perforation during percutaneous coronary intervention of chronic total occlusions: the PROGRESS-CTO perforation score.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 41 citations in OpenAlex.
- Temporal trends and outcomes of long coronary chronic total occlusion interventions: the Japanese CTO-PCI expert registry.Cardiovascular intervention and therapeutics · 2026Article
- A practical approach to the management of percutaneous coronary intervention complications.Frontiers in cardiovascular medicine · 2026Review
- Minimalistic chronic total occlusion treatments using tip detection-antegrade dissection and re-entry: a case series.European heart journal. Case reports · 2025Article
- Tip detection-antegrade dissection and re-entry (TD-ADR) with integrated fluoroscopic and intravascular ultrasound images in chronic total occlusion: first case report of integrated TD-ADR technique.European heart journal. Case reports · 2024Article
- Controlled antegrade and retrograde subintimal tracking (CART) for recanalisation of chronic total occlusions.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2024Article
- Scores and algorithms in CTO PCI: "PROGRESS" or an exercise in futility?EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Article
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Authors and funding
25 authors at 13 institutions in 3 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundCoronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and often leads to serious adverse clinical events.
aimsWe sought to develop a risk score to predict clinical coronary artery perforation in patients undergoing CTO PCI.
methodsWe analysed clinical and angiographic parameters from 9,618 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO). Logistic regression prediction modelling was used to identify variables independently associated with clinical perforation, and the model was internally validated with bootstrapping. Clinical coronary artery perforation was defined as any perforation requiring treatment.
resultsThe incidence of clinical coronary perforation was 3.8% (n=367). Five factors were independently associated with perforation and were included in the score: patient age ≥65 years +1 point (odds ratio [OR] 1.79, 95% confidence interval [CI]: 1.37-2.33), moderate/severe calcification +1 point (OR 1.85, 95% CI: 1.41-2.42), blunt/no stump +1 point (OR 1.45, 95% CI: 1.10-1.92), use of antegrade dissection and re-entry +1 point (OR 2.43, 95% CI: 1.61-3.69), and use of the retrograde approach +2 points (OR 4.02, 95% CI: 2.95-5.46). The resulting score showed acceptable performance on receiver operating characteristic (ROC) curve (area under the curve [AUC]: 0.741, 95% CI: 0.712-0.773). The Hosmer-Lemeshow test indicated a good fit (p=0.991), and internal validation with bootstrapping demonstrated good agreement with the model with observed AUC: 0.736 (95% bias-corrected CI: 0.706-0.767).
conclusionsThe PROGRESS-CTO perforation score may be a useful tool for predicting clinical coronary perforation during CTO PCI.
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