The following is the summary of “Validation of the OPEN-CLEAN Chronic Total Occlusion Percutaneous Coronary Intervention Perforation Score in a Multicenter Registry” published in the February 2023 issue of Cardiovascular Disease by Simsek, et al.

One of the most prevalent and terrifying consequences of PCI for chronic total occlusion (CTO) is percutaneous coronary intervention (PCI). Recently, the OPEN-CLEAN (Coronary artery bypass graft, Length of occlusion, Ejection fraction, Age, calcificioN) perforation score was introduced, and its efficacy in an independent multicenter CTO PCI dataset was examined. Only 150 (6.6%) of 2,270 patients who underwent CTO PCI at 7 centers experienced coronary artery perforation. 

Patients with perforations were older (69 ± 10 vs. 65 ± 10, P<0.001), more likely to be women (89% vs 82%, P=0.010), more likely to have a history of prior coronary artery bypass graft (38% vs 20%, P<0.001), and more likely to have unfavorable angiographic characteristics such as a blunt stump (64% vs 42%,  P<0.001), proximal cap ambiguity (51% vs 33%, P<0.001), and moderate-severe calcification (57% vs 43%, P=0.001).  Patients with perforations had a decreased rate of technical success (69% vs. 85%, P<0.001). Good calibration was found (Hosmer-Lemeshow P=0.72), with an area under the receiver operating characteristic curve of 0.74 (95% confidence interval 0.68 to 0.79) for the OPEN-CLEAN perforation risk model. 

With increasing OPEN-CLEAN scores, researchers observed an increase in the likelihood of CTO PCI perforation, from 3.5% (scoring 0-1) to 5.3% (score 3), 7.1% (score 4), 11.5% (score 5), and 19.8% (score 6). (score 6 to 7). The OPEN-CLEAN perforation score appears to be beneficial for estimating the perforation risk for patients who received CTO PCI due to its good performance and ease of preprocedural calculation.