OPEN-CTO Mortality Model: Explanation and Clinical Context “OPEN-CTO” refers to the prospective multicenter Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion (OPEN-CTO) registry, which has served as an external validation cohort for contemporary CTO PCI risk tools. The most widely cited periprocedural mortality model for CTO PCI derives from the PROGRESS-CTO registry and was externally validated in OPEN-CTO. In the PROGRESS-CTO complication program, separate scores were developed for MACE, mortality, pericardiocentesis, and peri-procedural MI. For the mortality model, the key predictors consistently reported are older age, reduced ventricular function, prior CABG, moderate/severe target-vessel calcification, and the crossing technique (adr/retrograde vs. antegrade wire escalation). In-hospital mortality across large CTO PCI registries is low but non-negligible (~0.4% in contemporary series), and tamponade is a leading mechanism of death, underscoring the need for pre-procedural risk communication and prevention strategies (e.g., meticulous wire/penetration technique, bailout readiness). Because the original regression coefficients are paywalled, this calculator implements a transparent points-based proxy that mirrors the published variable set and the relative hazard ordering (e.g., retrograde & ADR higher than AWE; LVEF reduction carries greater weight than age alone). Outputs are categorized into very-low/low/intermediate/high risk bands anchored to published incidence ranges so they remain clinically interpretable while avoiding unwarranted precision. When possible, replace proxy scoring with site-specific outcomes or the exact coefficient-based implementation from the original paper’s supplement.
References:
Simsek B, et al. JACC Cardiovasc Interv. 2022;15(14):1413-1422 — PROGRESS-CTO complication scores; mortality model variables and internal validation. (See editorial and summaries for variable list and performance.)
Azzalini L, et al. Catheter Cardiovasc Interv. 2023;101(3):536-542 — External validation of PROGRESS-CTO complication scores in the OPEN-CTO registry; endpoints include in-hospital all-cause mortality.
Simsek B, et al. Circ Cardiovasc Interv. 2023;16(7):e012977 — Periprocedural mortality after CTO PCI in the PROGRESS network; mortality ≈0.4% with tamponade a predominant cause.
SOLACI summary of PROGRESS-CTO models (study digest with variable set and AUCs): “Progress-CTO Score: A Key New Tool to Plan CTO,” July 25, 2022.