New Criteria to Identify Patients at Higher Risk for Cardiovascular Complications After Percutaneous Coronary Intervention

doi:10.1016/j.amjcard.2022.11.029

The American Journal of Cardiology

Volume 189, 15 February 2023, Pages 22-30

https://doi.org/10.1016/j.amjcard.2022.11.029 Get rights and content

A universal definition to identify patients at higher risk of complications after percutaneous coronary intervention (PCI) is lacking. We aimed to validate a recently developed score to identify patients at increased risk of all-cause death after PCI. All consecutive patients from a large PCI registry not presenting with ST-elevation myocardial infarction or cardiogenic shock were included. Each patient was assigned a score obtained by summing the points associated with the following variables: age >80 years (3 points), dialysis (6 points), left ventricular ejection fraction <30% (2 points), and multivessel PCI (2 points). Patients were stratified in 3 groups: low risk (score 0), intermediate risk (score 2 to 3), or high risk (score ≥4). The primary outcome was all-cause death, and the secondary outcomes were major adverse cardiovascular events and major bleeding. Events were assessed at 1 year after PCI. Between January 2014 and December 2019, 12,689 patients underwent PCI. Compared with the 9,884 patients at low risk, those at intermediate and high risk had a fourfold (hazard ratio 3.99, 95% confidence interval 2.95 to 5.38) and ninefold (hazard ratio 9.55, 95% confidence interval 6.89 to 13.2) higher hazard for all-cause death at 1 year, respectively. The score had a good predictive value for all-cause death at 1 year (area under the curve 0.70). The risk of major adverse cardiovascular events and major bleeding increased consistently from the low- to the high-risk group. In conclusion, in patients who underwent PCI for stable ischemic heart disease or non–ST-elevation acute coronary syndrome, a score based on 4 variables well predicted the risk of all-cause death at 1 year.

Section snippets

Methods

All consecutive patients who underwent PCI at a large-volume tertiary-care center (Mount Sinai Hospital, New York, New York) between January 2014 and December 2019 were considered for inclusion. Patients presenting with acute ST-elevation myocardial infarction (STEMI) or cardiogenic shock were excluded. In agreement with the risk assessment tool developed by Brener et al,¹⁷ each patient was assigned a score obtained by summing the points associated with the following 4 variables: age >80 years

Results

Between January 2014 and December 2019, a total of 22,795 PCI procedures were performed at Mount Sinai Hospital. After the exclusion of repeated procedures, 15,322 unique patients who underwent PCI were identified. Of those, 556 patients meeting the exclusion criteria (STEMI or cardiogenic shock), 389 with missing information on the 4 variables, preventing the score calculation, and 1,688 event-free patients lost from follow-up in the first 30 days were excluded. The final study population

Discussion

We validated the value of a new developed score, including 4 variables, to predict the risk of all-cause death and ischemic or bleeding events at 1 year in a cohort of 12,689 patients who underwent PCI for stable ischemic heart disease or NSTE-ACS. The main findings can be summarized as follows:

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Patients at intermediate (score 2 to 3) or high risk (score ≥4) were older and were more likely to be women, to have cardiovascular co-morbidities, and have a higher CAD complexity than patients at low

Impact on Daily Practice

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Patients at higher risk of complications after (PCI) represent a vulnerable and understudied population. A universal definition to identify these patients is currently lacking.
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Among patients who underwent PCI with stable ischemic heart disease or NSTE-ACS, a score based on 4 variables including age, dialysis, ejection fraction, and multivessel PCI allowed to identify patients at low, intermediate, or high risk of all-cause death, MACE, and major bleeding.
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This score represents a new

Disclosures

Dr. Spirito received a research grant from the Swiss National Science Foundation. Dr. Brener reports consulting and speaking fees from AstraZeneca. Dr. Baber reports speaker honoraria from AstraZeneca and Boston Scientific. Dr. Sharma has received consulting fees or honoraria from Abbott, Boston Scientific, Abiomed, and Cardiovascular Systems, Inc. Dr. Dangas reports institutional research grants from Abbott Laboratories, AstraZeneca, Bayer, Boston Scientific, Medtronic, and Daiichi‐Sankyo;

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Cited by (3)

Clinical Use of CathPCI Registry Risk Score and Its Validation to Predict Long-Term Mortality
2023, American Journal of Cardiology
Risk models to estimate percutaneous coronary intervention (PCI) mortality have limited value in complex high-risk patients. However, it was improved by a recently developed bedside model to predict in-hospital mortality using data from the American College of Cardiology CathPCI Registry that included 706,263 patients. The median risk-standardized in-hospital mortality rate was 1.9%. In an attempt to validate this model in patients admitted because of acute coronary ischemia to predict in-hospital, 30-day, and 1-year mortality, we applied the proposed risk score to the study population of the Acute Coronary Syndrome Israeli Survey (ACSIS). This study was conducted for 2 months in 2018 and included all patients admitted to 25 coronary care units and cardiology departments in Israel. The ACSIS included 1,155 patients admitted because of acute myocardial infarction and who underwent PCI. In-hospital, 30-day, and 1-year mortality were 2.3%, 3.1%, and 6.2%, respectively. The CathPCI risk score yielded an area under the receiver operating characteristic curve of 0.96 (95% confidence interval [CI] 0.94 to 0.99) for in-hospital mortality; 0.96 (95% CI 0.94 to 0.98) for the 30-day mortality, and 0.88 (95% CI 0.83 to 0.93) for the 1-year mortality. The current model also included frail patients, and those with aortic stenosis, refractory shock, and after cardiac arrest. In conclusion, the CathPCI Registry risk score was validated using data from the ACSIS. Because the ACSIS population comprised patients with acute ischemia including those with high-risk features this model demonstrates a wider scope of application compared with previous ones. In addition, the model seems to be suitable to predict also the 30-day and 1-year mortality.
Validation of UK-BCIS CHIP Score to Predict 1-Year Outcomes in a Contemporary United States Population
2023, JACC: Cardiovascular Interventions
A complex high-risk indicated percutaneous coronary intervention (CHIP) score was recently developed from the British Cardiovascular Intervention Society (BCIS) database to define CHIP cases and their risk of in-hospital major adverse cardiac or cerebrovascular events (MACCE).
The authors sought to apply this score to a contemporary U.S. population for the prediction of adverse events at 1 year following percutaneous coronary intervention (PCI).
Consecutive patients undergoing PCI at a large tertiary care center between 2011 and 2020 were considered for inclusion. Patients were categorized into 4 groups based on their BCIS-CHIP score (0, 1-2, 3-4, ≥5). In each category, we assessed the 1-year risk of MACCE, a composite of all-cause death, myocardial infarction, and stroke. Secondary outcomes were the individual components of MACCE, and major bleeding at 1 year.
Among 20,799 patients included, MACCE at 1 year occurred in 1.7% patients with score 0 (reference), 3.0% with score 1 or 2 (HR: 1.72; 95% CI: 1.32-2.24), 6.1% with score 3 or 4 (HR: 3.60; 95% CI: 2.78-4.66), and 12.0% with score ≥5 (HR: 7.40; 95% CI: 5.75-9.51). Each point increase of the BCIS-CHIP score conferred a 28.0% increase of MACCE risk. The BCIS-CHIP score demonstrated good discrimination for the prediction of 1-year MACCE (C-index 0.70). The risk of secondary outcomes also progressively increased with higher score values.
In a large PCI registry, the BCIS-CHIP score had a good predictive value for MACCE at 1 year. The utilization of this score can facilitate an accurate risk stratification of patients undergoing PCI.
Predictive value of the thrombotic risk criteria proposed in the 2023 ESC guidelines for the management of ACS: insights from a large PCI registry
2024, European Heart Journal - Cardiovascular Pharmacotherapy

: Funding: none.

: This study was supported by the Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York, New York.

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New Criteria to Identify Patients at Higher Risk for Cardiovascular Complications After Percutaneous Coronary Intervention

Section snippets

Methods

Results

Discussion

Impact on Daily Practice

Disclosures

Cardiovasc Revasc Med

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Lancet

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Lancet

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol