This was a retrospective study. Data collection on 474 patients undergoing a difficult IS-CTO PCI was conducted from January 2015 to December 2018. J-CTO scores were obtained from multicenter chronic total occlusion registry of Japan. Target-vessel myocardial infarction (MI), cardiac death, or ischemia driven target-vessel revascularization (TVR) at follow-up were the primary endpoints (major adverse cardiovascular events (MACE)). With the help of the Youden index, cut-off points were estimated. 

Overall, the procedural success rate was 77.6%. Multivariable analysis was performed. Factors including proximal bending (beta coefficient [β] = 3.465), tortuosity (β = 3.064), stent under expansion (β = 3.109), and poor distal landing zone (β = 1.959) were associated with technical failure via antegrade approach but not the J-CTO score (OR = 0.632; 95% CI [0.352-1.134]; P 0.124). A median follow-up of 30 months was done (interquartile range: 17-42 months). Multivariable analysis demonstrated that receiving >18 months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of MACE (HR: 2.690; 95% CI: 1.346-5.347; P = 0.005). However, the J-CTO score was no an independent predictor of MACE (HR: 1.018; 95% CI: 0.728-1.424; P = 0.917).  

Hence, to predict the technical success of difficult IS-CTO PVI via antegrade approach, J-CTO score system is not helpful. It does not correspond with long-term outcomes in patients undergoing IS-CTO PCI. Proximal bending ≥30 degrees, under expansion of ≥10mm, moderate or severe tortuosity (bending) ≥20, and poor distal target were the factors associated with technical failure. Long-term DAPT therapy contributed significantly to reduced MACE. 


Disease Condition,Therapeutic Modality,Coronary Artery Disease,Interventional Cardiology,Acute Coronary Syndrome,Percutaneous Coronary Intervention



Disease Condition ,Therapeutic Modality ,Coronary Artery Disease,Interventional Cardiology,Acute Coronary Syndrome,Percutaneous Coronary Intervention