Causal Models for the Result of Percutaneous Coronary Intervention in Coronary Chronic Total Occlusions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Definitions
- The degree of calcification was visually estimated on fluoroscopy, defined as moderate when one-half of the total CTO segment exhibited visible residues, and as severe when the extension of calcification was >50% of the segment.
- Arterial tortuosity arises from abnormal elongation of the arteries and is characterized by blood vessel abnormalities, particularly abnormal twists and turns. The CTO was defined as straight if the pre-occlusive segment contained a bend of <70; moderate when a segment contained either two bends >70, or one bend >90; and as severe when it contained either two or more pre-occlusive bends of >90, or at least one bend of >120.
- The length of coronary occlusions was visually estimated from angiographic projections with single- or dual-contrast injections.
- Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. It is characterized by long-term respiratory symptoms and airflow limitation.
- The morphology of the vessel stump was characterized as tapered, blunt, or unseen, depending on its appearance on fluoroscopy. The angiographic assessment of collateral connections was made according to the Werner classification.
- Dyslipidemia is present when an abnormally high amount of lipids is present.
- Renal failure is a long-term condition of kidney malfunction.
- Family history of coronary disease is present when one or more close relatives had early coronary artery disease (men <55 years, women <65 years).
- Peripheral disease was defined when abnormal narrowing of arteries was present.
- Segmental regional abnormalities were defined as regional abnormalities in contractile function.
- Previous MI was defined as documented history of previous myocardial infarction.
- In-stent CTO was defined when CTO inside a previous PCI existed.
- CTO location represented the vessel in which the CTO is located.
- Previous CABG corresponded to history of coronary artery bypass surgery.
- Technical success was defined as a residual stenosis of <10% at the end of the procedure with TIMI flow grade three antegrade flow.
2.3. PC Algorithm
2.4. Statistical Analysis
2.4.1. Preprocessing
2.4.2. Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Variable | Operation Success n = 1513 | Operation Failure n = 1513 |
---|---|---|
Calcification (%) None/Mild (spots) Moderate(<=50% RLD) Severe (>50% RLD) | 902 (59.6) 407 (26.9) 204 (13.5) | 583 (38.5) 464 (30.7) 466 (30.8) |
Segmental regional (%) Normal H/A/D | 835 (55.2) 678 (44.8) | 678 (44.8) 835 (55.2) |
Age, mean (SD) | 64.12 (10.6) | 65.21 (10.1) |
Weight, mean (SD) | 84.31 (16.5) | 84.47 (16.4) |
Family history (%) No Yes | 1059 (70.0) 454 (30.0) | 1065 (70) 448 (29.6) |
Dyslipidemia (%) No Yes | 338 (22.3) 1175 (77.7) | 303 (20.0) 1210 (80.0) |
Diabetes (%) No Yes | 1045 (69.1) 468 (30.9) | 1025 (67.8) 488 (32.3) |
Peripheral disease (%) No Yes | 1369 (90.5) 144 (9.5) | 1314 (88.8) 199 (13.2) |
COPD (%) No Yes | 1429 (94.4) 84 (5.5) | 1411 (93.3) 102 (6.7) |
Prior stroke (%) No Yes | 1472 (97.3) 41 (2.7) | 1456 (96.2) 57 (3.8) |
Renal failure (%) No Yes | 1495 (98.8) 18 (1.2) | 1498 (99.0) 15 (1.0) |
Previous MI (%) No Yes | 940 (62.1) 573 (37.9) | 901 (59.6) 612 (40.5) |
Previous CABG (%) No Yes | 1325 (87.6) 188 (12.4) | 1239 (81.9) 274 (18.1) |
Previous PCI (%) No Yes | 795 (52.5) 718 (47.5) | 730 (48.3) 783 (51.8) |
CTO location (%) Ostial Proximal Mid Distal | 156 (10.3) 649 (42.9) 607 (40.1) 101 (6.7) | 219 (14.5) 638 (42.2) 571 (37.7) 85 (5.6) |
In stent CTO (%) No Yes | 1401 (92.6) 112 (7.4) | 1409 (93.1) 104 (6.9) |
Bifurcation involvement (%) No Yes | 1217 (80.4) 296 (19.6) | 1262 (83.4) 251 (16.6) |
CTO length, mean (SD) | 28.28 (18.6) | 36.23 (22.1) |
Vessel diameter, mean (SD) | 2.93 (0.4) | 2.90 (0.5) |
Proximal tortuosity (%) Straight Moderate Severe | 1098 (72.6) 336 (22.2) 79 (5.2) | 822 (54.3) 463 (30.6) 228 (15.1) |
Stump (%) No stump Tapered stump Blunt stump | 171 (11.3) 745 (49.2) 597 (39.5) | 358 (23.7) 413 (27.3) 742 (49.0) |
Variable | Operation Success n = 10,647 | Operation Failure m = 1513 |
---|---|---|
Calcification (%) None/Mild (spots) Moderate (<=50% RLD) Severe (>50% RLD) | 6270 (58.9) 2877 (27.0) 1500 (14.1) | 583 (38.5) 464 (30.7) 466 (30.8) |
Segmental regional (%) Normal H/A/D | 5658 (53.1) 4989 (46.9) | 678 (44.8) 835 (55.2) |
Age, mean (SD) | 64.06 (10.7) | 65.21 (10.1) |
Weight, mean (SD) | 84.32 (16.3) | 84.47 (16.4) |
Family history (%) No Yes | 7379 (69.3) 3268 (30.7) | 1065 (70.4) 448 (29.6) |
Dyslipidemia (%) No Yes | 2356 (22.1) 8291 (77.9) | 303 (20.0) 1210 (80.0) |
Diabetes (%) No Yes | 7382 (69.3) 3265 (30.7) | 1025 (67.8) 488 (32.3) |
Peripheral disease (%) No Yes | 9611 (90.3) 1036 (9.7) | 1314 (88.8) 199 (13.2) |
COPD (%) No Yes | 10108 (94.9) 539 (5.1) | 1411 (93.3) 102 (6.7) |
Prior stroke (%) No Yes | 10363 (97.3) 284 (2.7) | 1456 (96.2) 57 (3.8) |
Renal failure (%) No Yes | 10536 (99.0) 111 (1.0) | 1498 (99.0) 15 (1.0) |
Previous MI (%) No Yes | 6601 (62.0) 4046 (38.0) | 901 (59.6) 612 (40.5) |
Previous CABG (%) No Yes | 9324 (87.6) 1323 (12.4) | 1239 (81.9) 274 (18.1) |
Previous PCI (%) No Yes | 5591 (52.5) 5056 (47.5) | 730 (48.3) 783 (51.8) |
CTO location (%) Ostial Proximal Mid Distal | 1018 (9.6) 4581 (43.0) 4311 (40.5) 737 (6.9) | 219 (14.5) 638 (42.2) 571 (37.7) 85 (5.6) |
In stent CTO (%) No Yes | 9793 (92.0) 854 (8.0) | 1409 (93.1) 104 (6.9) |
Bifurcation involvement (%) No Yes | 8526 (80.1) 2121 (19.9) | 1262 (83.4) 251 (16.6) |
CTO length, mean (SD) | 28.72 (18.8) | 36.23 (22.1) |
Vessel diameter, mean (SD) | 2.94 (0.4) | 2.90 (0.5) |
Proximal tortuosity (%) Straight Moderate Severe | 7535(70.8) 2567(24.1) 545(5.1) | 822 (54.3) 463 (30.6) 228 (15.1) |
Stump (%) No stump Tapered stump Blunt stump | 1219 (11.5) 5088 (47.8) 4340 (40.8) | 358 (23.7) 413 (27.3) 742 (49.0) |
Variable | Operation Success n = 4562 | Operation Failure n = 648 |
---|---|---|
Calcification (%) None/Mild (spots) Moderate (<=50% RLD) Severe (>50% RLD) | 2714 (59.5) 1167 (25.6) 681 (14.9) | 246 (38.0) 178 (27.5) 224 (34.6) |
Segmental regional (%) Normal H/A/D | 2430 (53.3) 2132 (46.7) | 277 (42.8) 371 (57.3) |
Age, mean (SD) | 63.98 (10.6) | 65.53 (10.5) |
Weight, mean (SD) | 84.34 (16.1) | 85.89 (16.8) |
Family history (%) No Yes | 3132 (68.7) 1430 (31.4) | 444 (68.5) 204 (31.5) |
Dyslipidemia (%) No Yes | 1027 (22.5) 3535 (77.5) | 143 (22.1) 505 (77.9) |
Diabetes (%) No Yes | 3096 (67.9) 1466 (32.1) | 411 (63.4) 237 (36.6) |
Peripheral disease (%) No Yes | 4106 (90.0) 456 (10.0) | 543 (83.8) 105 (16.2) |
COPD (%) No Yes | 4339 (95.1) 223 (4.9) | 594 (91.7) 54 (8.3) |
Prior stroke (%) No Yes | 4440 (97.3) 122 (2.7) | 625 (96.5) 23 (3.6) |
Renal failure (%) No Yes | 4508 (98.8) 54 (1.2) | 638 (98.5) 10 (1.5) |
Previous MI (%) No Yes | 2831 (62.1) 1731 (37.9) | 365 (56.3) 283 (43.7) |
Previous CABG (%) No Yes | 3985 (87.4) 577 (12.7) | 516 (79.6) 132 (20.4) |
Previous PCI (%) No Yes | 2357 (51.7) 2205 (48.3) | 300 (46.3) 348 (53.7) |
CTO location (%) Ostial Proximal Mid Distal | 451 (9.9) 1985 (43.5) 1822 (39.9) 304 (6.7) | 84 (13.0) 272 (42.0) 250 (38.6) 42 (6.5) |
In stent CTO (%) No Yes | 4144 (90.9) 418 (9.2) | 614 (94.8) 34 (5.3) |
Bifurcation involvement (%) No Yes | 3653 (80.1) 909 (19.9) | 516 (79.6) 132 (20.4) |
CTO length, mean (SD) | 29.07 (19.7) | 37.27 (22.9) |
Vessel diameter, mean (SD) | 2.94 (0.4) | 2.91 (0.4) |
Proximal tortuosity (%) Straight Moderate Severe | 3173 (69.6) 1161 (25.5) 228 (5.0) | 369 (57.0) 200 (30.9) 79 (12.2) |
Stump (%) No stump Tapered stump Blunt stump | 538 (11.8) 2190 (48.0) 1834 (40.2) | 151 (23.3) 171 (26.4) 326 (50.3) |
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95% Confidence Interval for Exp (B) | ||||
---|---|---|---|---|
Variables | Exp (B) | Lower | Upper | p-Value |
(Intercept) | 1.501 | 1.17 | 1.93 | 0.001 |
Calcification_None/Mild (spots) | 1.000 | |||
Calcification_Moderate (<=50% RLD) | 0.697 | 0.58 | 0.84 | <0.001 |
Calcification_Severe (>50% RLD) | 0.395 | 0.32 | 0.49 | <0.001 |
Segmental regional_Normal | 1.000 | |||
Segmental regional_H/A/D | 0.674 | 0.58 | 0.79 | <0.001 |
CTO length | 0.986 | 0.98 | 0.99 | <0.001 |
Proximal tortuosity_Straight | 1.000 | |||
Proximal tortuosity_Moderate | 0.671 | 0.56 | 0.80 | <0.001 |
Proximal tortuosity_Severe | 0.355 | 0.27 | 0.47 | <0.001 |
Stump_No | 1.000 | |||
Stump_Tapered | 3.237 | 2.58 | 4.07 | <0.001 |
Stump_Blunt | 1.946 | 1.56 | 2.43 | <0.001 |
Accuracy Measures MBFS | |
---|---|
Overall Accuracy | 0.6647 |
Sensitivity | 0.6662 |
Specificity | 0.6543 |
AUROC | 0.7145 |
Model Name | # of Features | FEATURES USED | AIC | AUROC |
---|---|---|---|---|
MBFS | 5 | Segmental, Proximal tortuosity, Calcification, Stump, CTO length | 3751.7 | 0.715 |
CASTLE | 6 | Previous CABG, Age, Proximal tortuosity, Calcification, Stump, CTO length | 3774 | 0.710 |
JCTO | 5 | Proximal tortuosity, Calcification, Stump, CTO length, Previously failed lesion | 3760.6 | 0.708 |
RECHARGE | 5 | Previous CABG, Proximal tortuosity, Calcification, Stump, CTO length | 3774.1 | 0.709 |
CL | 6 | Previous CABG, Previous MI, Calcification, Stump, CTO length, n-LAD | 3841.7 | 0.706 |
PROGRESS | 4 | Previous PCI, Proximal tortuosity, Stump, CTO artery | 3915.1 | 0.659 |
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Ganopoulou, M.; Kangelidis, I.; Sianos, G.; Angelis, L. Causal Models for the Result of Percutaneous Coronary Intervention in Coronary Chronic Total Occlusions. Appl. Sci. 2021, 11, 9258. https://doi.org/10.3390/app11199258
Ganopoulou M, Kangelidis I, Sianos G, Angelis L. Causal Models for the Result of Percutaneous Coronary Intervention in Coronary Chronic Total Occlusions. Applied Sciences. 2021; 11(19):9258. https://doi.org/10.3390/app11199258
Chicago/Turabian StyleGanopoulou, Maria, Ioannis Kangelidis, Georgios Sianos, and Lefteris Angelis. 2021. "Causal Models for the Result of Percutaneous Coronary Intervention in Coronary Chronic Total Occlusions" Applied Sciences 11, no. 19: 9258. https://doi.org/10.3390/app11199258
APA StyleGanopoulou, M., Kangelidis, I., Sianos, G., & Angelis, L. (2021). Causal Models for the Result of Percutaneous Coronary Intervention in Coronary Chronic Total Occlusions. Applied Sciences, 11(19), 9258. https://doi.org/10.3390/app11199258