The Relationship Between the CASTLE (EUROCTO) Score and Contrast-Induced Nephropathy in Patients Undergoing Coronary Chronic Total Occlusion Interventions

Abstract

Background: Contrast-induced nephropathy (CIN) is still recognized as a major complication in patients undergoing chronic total occlusion (CTO) interventions. The predictive value of CTO complexity scores for CIN remains unclear. The present study investigated whether the CASTLE (EuroCTO) score is associated with the development of CIN in patients treated with CTO-PCI. Methods: A total of 356 patients undergoing CTO-PCI were retrospectively analyzed and classified according to CIN development. Clinical, angiographic, and procedural characteristics were compared between groups. Missing data were handled using multiple imputation, and independent predictors of CIN were identified through multivariable logistic regression analysis. The predictive performance of CTO scoring systems was evaluated using receiver operating characteristic (ROC) curve analysis. Results: CIN was observed in 34 patients (9.5%). Individuals who developed CIN were generally older, more frequently diabetic, and had lower left ventricular ejection fraction values. Procedural complexity was greater in the CIN group, reflected by higher CASTLE and J-CTO scores, longer lesion length, and higher contrast volume. In multivariable analysis, the CASTLE score remained associated with CIN (OR: 1.838, 95% CI: 1.354–2.494, p<0.001), whereas the association with the J-CTO score was weaker, and the PROGRESS CTO score was not significant. ROC analysis demonstrated that the CASTLE score showed acceptable discriminative performance (AUC: 0.694, 95% CI: 0.643–0.742), with a cut-off >2 providing a reasonable balance between sensitivity (70.6%) and specificity (63.3%). Conclusion: The CASTLE (EuroCTO) score showed an association with CIN occurrence in patients treated with CTO-PCI and demonstrated acceptable predictive capability compared with other CTO scoring models. Although the score may contribute to preprocedural risk assessment, the results should be interpreted carefully.

Keywords

• Coronary artery disease
• Chronic total occlusion
• CASTLE score; contrast-induced nephropathy
• percutaneous coronary intervention; acute kidney injury

Koroner Kronik Total Oklüzyon Girişimi Uygulanan Hastalarda CASTLE (EUROCTO) Skoru ile Kontrast Kaynaklı Nefropati Arasındaki İlişki

Abstract

Amaç: Kontrast ilişkili nefropati (KI􀇚N), kronik total oklüzyon (KTO) girişimlerinde önemli komplikasyonlardan biri olmaya devam etmektedir. KTO lezyon kompleksitesini değerlendirmede kullanılan skorların KI􀇚N gelişimini öngörmedeki rolü henüz net değildir. Bu çalışmada, kronik total oklüzyon-perkütan koroner girişim (KTO-PKG) uygulanan hastalarda CASTLE (EuroCTO) skorunun KI􀇚N gelişimi ile ilişkisi araştırıldı.Yöntemler: KTO-PKG uygulanan toplam 356 hasta retrospektif olarak değerlendirildi ve KI􀇚N gelişimine göre iki gruba ayrıldı. Gruplar arasında klinik, anjiyografik ve prosedürel özellikler karşılaştırıldı. Eksik veriler çoklu imputasyon yöntemi ile tamamlandı. KI􀇚N’in bağımsız belirleyicileri çok değişkenli lojistik regresyon analizi ile değerlendirildi. KTO skorlama sistemlerinin öngörü performansı receiver operating characteristic (ROC) eğrisi analizi ile incelendi. Bulgular: KI􀇚N, 34 (%9,5) hastada gelişti. KI􀇚N gelişen hastalar daha ileri yaşta olup diyabetes mellitus sıklığı daha yüksek ve sol ventrikül ejeksiyon fraksiyonu daha düşüktü. KI􀇚N grubunda prosedürel kompleksite daha yüksek olup, bu durum daha yüksek CASTLE ve Japanese chronic total occlusion (J-CTO) skorları, daha uzun lezyon uzunluğu ve daha fazla kontrast madde kullanımı ile ilişkiliydi. Çok değişkenli analizde CASTLE skoru, KI􀇚N gelişimi ile bağımsız olarak ilişkili bulundu (OR: 1,838; %95 güven aralığı [GA]: 1,354–2,494; p<0,001). J-CTO skorunun ilişkisi daha zayıfken, PROGRESS CTO skoru anlamlı bulunmadı. ROC analizinde CASTLE skorunun orta düzeyde ayırt edici performans gösterdiği saptandı (eğri altında alan [EAA]: 0,694; %95 GA: 0,643–0,742). >2 eşik değeri, duyarlılık (%70,6) ve özgüllük (%63,3) açısından en uygun dengeyi sağladı.Sonuç: CASTLE skoru, KTO-PKG uygulanan hastalarda KI􀇚N gelişimi ile ilişkili bulundu ve diğer KTO skorlama sistemlerine kıyasla daha iyi öngörü performansı gösterdi. CASTLE skoru, işlem öncesi risk değerlendirmesinde yararlı olabilir; ancak bulguların prospektif çalışmalarla doğrulanması gerekmektedir.

Keywords

• Koroner arter hastalığı
• kronik total oklüzyon
• CASTLE skoru
• kontrast ilişkili nefropati
• perkütan koroner girişim
• akut böbrek hasarı

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