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Background <p>The J-CTO score is a well-established tool for evaluating lesion complexity and predicting procedural success in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The extent of coronary collateral circulation, typically graded using the Rentrop classification, is an important determinant of myocardial viability and procedural planning. However, the interplay between anatomical lesion complexity and the development of collateral vessels remains incompletely elucidated.</p> Objectives <p>This study aimed to investigate the relationship between J-CTO scores and Rentrop collateral grades in patients with CTO undergoing coronary angiography for chronic coronary syndrome (CCS).</p> Methods <p>In this single-center, retrospective study, a total of 243 patients with chronic coronary syndrome and angiographically confirmed CTO lesions, who underwent evaluation between October 2022 and October 2024, were included. Patients were categorized according to their J-CTO scores into two groups: a low J-CTO group (score 0–1) and a high J-CTO group (score ≥ 2). Collateral circulation was assessed using the Rentrop grading system (Grades 0–3). Clinical, laboratory, and angiographic parameters, as well as the Rentrop classification, were compared between the groups.</p> Results <p>Patients in the high J-CTO group (score ≥ 2; <i>n</i> = 159) exhibited a significantly greater prevalence of advanced collateral circulation compared with the low J-CTO group (score 0–1; <i>n</i> = 84; <i>p</i> &lt; 0.001). Partial or complete collateral filling (Rentrop Grades 2–3) was observed in 79.2% of patients in the high J-CTO group versus 13.1% in the low J-CTO group. Despite a metabolically less favorable profile, left ventricular ejection fraction was significantly higher in the high J-CTO group (52.5% vs. 48.7%, <i>p</i> = 0.003). J-CTO score demonstrated a strong monotonic association with Rentrop grade (Spearman <i>r</i> = 0.671, <i>p</i> &lt; 0.001). ROC analysis revealed that J-CTO score predicted advanced collateral development (Rentrop ≥ 2) with an AUC of 0.851 (95% CI: 0.800–0.902; sensitivity 92.0%, specificity 68.9% at cut-off ≥ 2). On multivariate logistic regression, higher J-CTO score (OR 1.67, 95% CI 1.20–2.32, <i>p</i> = 0.002) and longer estimated ischemic duration (OR 1.14, 95% CI 1.06–1.22, <i>p</i> &lt; 0.001) independently predicted Rentrop Grades 2–3.</p> Conclusions <p>Elevated J-CTO scores are significantly associated with more advanced coronary collateral development as assessed by the Rentrop classification, and with relatively higher left ventricular ejection fraction. These associations are consistent with adaptive vascular responses to prolonged ischemia; however, given the cross-sectional retrospective design, the exclusion of statin users, and the modest sample size, causal inferences cannot be drawn and generalizability is limited. These findings are hypothesis-generating and require prospective multicenter validation.</p>

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Evaluation of the relationship between the J-CTO score and rentrop classification in patients with chronic coronary syndrome and chronic total occlusion

  • 期刊论文

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  • 发表日期：

    2026年7月8日

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  • Ecem Gürses,
  • Gamze Yeter Arslan

摘要

Background

The J-CTO score is a well-established tool for evaluating lesion complexity and predicting procedural success in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The extent of coronary collateral circulation, typically graded using the Rentrop classification, is an important determinant of myocardial viability and procedural planning. However, the interplay between anatomical lesion complexity and the development of collateral vessels remains incompletely elucidated.

Objectives

This study aimed to investigate the relationship between J-CTO scores and Rentrop collateral grades in patients with CTO undergoing coronary angiography for chronic coronary syndrome (CCS).

Methods

In this single-center, retrospective study, a total of 243 patients with chronic coronary syndrome and angiographically confirmed CTO lesions, who underwent evaluation between October 2022 and October 2024, were included. Patients were categorized according to their J-CTO scores into two groups: a low J-CTO group (score 0–1) and a high J-CTO group (score ≥ 2). Collateral circulation was assessed using the Rentrop grading system (Grades 0–3). Clinical, laboratory, and angiographic parameters, as well as the Rentrop classification, were compared between the groups.

Results

Patients in the high J-CTO group (score ≥ 2; n = 159) exhibited a significantly greater prevalence of advanced collateral circulation compared with the low J-CTO group (score 0–1; n = 84; p < 0.001). Partial or complete collateral filling (Rentrop Grades 2–3) was observed in 79.2% of patients in the high J-CTO group versus 13.1% in the low J-CTO group. Despite a metabolically less favorable profile, left ventricular ejection fraction was significantly higher in the high J-CTO group (52.5% vs. 48.7%, p = 0.003). J-CTO score demonstrated a strong monotonic association with Rentrop grade (Spearman r = 0.671, p < 0.001). ROC analysis revealed that J-CTO score predicted advanced collateral development (Rentrop ≥ 2) with an AUC of 0.851 (95% CI: 0.800–0.902; sensitivity 92.0%, specificity 68.9% at cut-off ≥ 2). On multivariate logistic regression, higher J-CTO score (OR 1.67, 95% CI 1.20–2.32, p = 0.002) and longer estimated ischemic duration (OR 1.14, 95% CI 1.06–1.22, p < 0.001) independently predicted Rentrop Grades 2–3.

Conclusions

Elevated J-CTO scores are significantly associated with more advanced coronary collateral development as assessed by the Rentrop classification, and with relatively higher left ventricular ejection fraction. These associations are consistent with adaptive vascular responses to prolonged ischemia; however, given the cross-sectional retrospective design, the exclusion of statin users, and the modest sample size, causal inferences cannot be drawn and generalizability is limited. These findings are hypothesis-generating and require prospective multicenter validation.