Impact of Chronic Total Occlusions on Revascularization Scores and Outcome Prediction

Björn Redfors, Tullio Palmerini, Adriano Caixeta, Girma Minalu Ayele, Dominic P. Francese, Roxana Mehran, Emmanouil S. Brilakis, Ajay J. Kirtane, Dimitri Karmpaliotis, Gregg W. Stone, Philippe Généreux

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


OBJECTIVES: To evaluate the contribution of chronic total occlusion (CTO)-related SYNTAX score (SS) to the overall SS for patients with CTO and compare the traditional SS to a simplified variant. The SS algorithm assigns CTO lesions a greater weight (5× points) than non-CTO lesions (50% to <100% diameter stenosis; 2× points). METHODS: We calculated the SS and the simplified SS (2× points also to CTO lesions) for 4356 patients from the angiographic substudy of the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. We compared the association between SS and 1-year mortality and major adverse cardiac events for patients with and without a CTO. We also compared the simplified SS with the traditional SS. RESULTS: The median SS was 20 (interquartile range, 13-27.5) for patients with a CTO and 8 (interquartile range, 2-16) for patients without a CTO. For patients with a CTO, the CTO lesion(s) contributed 67 ± 26% of the total SS. The simplified SS reclassified 187/603 (31.0%) of patients with a SS >22 to a SS ≤22. The traditional SS did not improve discrimination indices for predicting outcomes compared with the simplified SS. CONCLUSIONS: CTO lesions contribute considerably to the total SS in patients with a CTO. A simplified SS that does not differentiate between CTO and non-CTO lesions appeared equivalent to the traditional SS for risk prediction, but reclassified a substantial proportion of patients to a SS ≤22 and may impact choice of revascularization strategy for patients with complex coronary artery disease involving a CTO lesion.

Original languageEnglish
Pages (from-to)123-131
Number of pages9
JournalJournal of Invasive Cardiology
Issue number4
StatePublished - Apr 2017


  • Non'ST elevation acute coronary syndromes
  • SYNTAX score
  • coronary artery bypass grafting


Dive into the research topics of 'Impact of Chronic Total Occlusions on Revascularization Scores and Outcome Prediction'. Together they form a unique fingerprint.

Cite this