Development and validation of a predictive score for anterograde crossing of infrapopliteal chronic total occlusions: (The Infrapop‐CTO Score)
| Autor: | John R. Laird, Bejan Alvandi, Moosa N. Haider, Aaron Strobel, Gagan D. Singh, Stephen W. Waldo, Ehrin J. Armstrong, Damianos G. Kokkinidis, Omar Jawaid |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Scoring system Critical Illness medicine.medical_treatment 030204 cardiovascular system & hematology Revascularization Risk Assessment Peripheral Arterial Disease 03 medical and health sciences 0302 clinical medicine Ischemia Predictive Value of Tests Risk Factors Clinical Decision Rules Internal medicine Humans Medicine Popliteal Artery Radiology Nuclear Medicine and imaging 030212 general & internal medicine Retrospective Studies business.industry Endovascular Procedures Reproducibility of Results General Medicine Critical limb ischemia Stepwise regression Treatment Outcome Chronic Disease Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business Major amputation |
| Zdroj: | Catheterization and Cardiovascular Interventions. 95:748-755 |
| ISSN: | 1522-726X 1522-1946 |
| DOI: | 10.1002/ccd.28693 |
| Popis: | Patients with critical limb ischemia often have infrapopliteal (IP) chronic total occlusions (CTOs). While revascularization is indicated to prevent major amputation, anterograde crossing of these lesions can be challenging, with high failure rates.To develop and validate a scoring system that can adequately predict successful anterograde crossing of infrapopliteal CTOs.A total of 213 IP CTOs (147 successfully crossed with the anterograde approach vs. 66 where anterograde crossing failed) were included in the analysis. Backwards stepwise selection (p for retention.05) was used to create a multivariable logistic regression model for the prediction of successful anterograde crossing using variables that were found to have a p .1 in univariate analysis. The model was internally validated with bootstrapping and demonstrated excellent discriminatory ability (C-statistic 0.78 and Hosmer-Lemeshow p value = .61). A point score based on the beta-coefficient of the model variables was created, with one point assigned for presence of a noncentral (blunt) stump, one point for severe calcification at the entry site, and two points each for non-restenotic lesions or lesion length 200 mm. The score was shown to have an excellent discriminatory ability for successful crossing, with low scores (0-2) associated with low failure rates (10%) and high scores associated with high failure rates (79%).The Infrapop-CTO score can stratify the procedural complexity of IP CTOs based on the likelihood of successful anterograde crossing. This score may help to direct optimal approaches toward infrapopliteal revascularization of patients with critical limb ischemia. |
| Databáze: | OpenAIRE |
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