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Published on: May 14, 2013
Development and validation of a stent thrombosis risk score in patients with acute coronary syndromes
George D Dangas1, Bimmer E Claessen, Roxana Mehran
1Department of Cardiology, Mount Sinai Medical Center, New York, NY 10029, USA. george.dangas@mssm.edu
Insights
A new risk score helps predict stent thrombosis (ST) after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). This tool uses clinical, angiographic, and procedural factors to assess individual patient risk, aiding personalized treatment strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Stent thrombosis (ST) is a serious complication following percutaneous coronary intervention (PCI) with stent implantation in patients with acute coronary syndromes (ACS).
- Accurate risk assessment for ST is crucial for personalizing patient management and improving outcomes after PCI.
- Existing risk stratification tools may not adequately address the specific needs of ACS patients undergoing PCI.
Purpose of the Study:
- To develop and validate a practical risk score for predicting the likelihood of stent thrombosis (ST) in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI).
- To identify key clinical, angiographic, and procedural factors associated with ST development within one year post-PCI.
- To provide a simple, actionable tool for clinicians to stratify ST risk in ACS patients.
Main Methods:
- A pooled patient-level analysis of 6,139 patients from the HORIZONS-AMI and ACUITY trials undergoing PCI for ACS was conducted.
- Patients were randomized to bivalirudin or heparin plus a glycoprotein IIb/IIIa inhibitor.
- A Cox regression model identified predictors of definite/probable ST at 1 year, with covariates assigned integer scores to form the risk score. The cohort was split into development (n=4,093) and validation (n=2,046) groups.
Main Results:
- The developed risk score incorporated variables such as ACS type, smoking, diabetes, prior PCI, platelet count, anticoagulant use, lesion characteristics, baseline and final TIMI flow, and number of treated vessels.
- One-year ST rates varied significantly across risk categories: low (1.36-1.65%), intermediate (3.06-2.77%), and high (9.18-6.45%) in development and validation cohorts, respectively (p<0.001).
- The risk score demonstrated good discriminatory ability with a C-statistic over 0.65 in both cohorts.
Conclusions:
- A simple risk score effectively predicts the individual risk of stent thrombosis (ST) after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS).
- The score integrates readily available clinical, angiographic, and procedural data, facilitating its use in routine practice.
- This tool can aid clinicians in tailoring preventive strategies and follow-up for ACS patients at higher risk of ST.
Objectives:
This study sought to develop a practical risk score to predict the risk of stent thrombosis (ST) after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).
Background:
ST is a rare, yet feared complication after PCI with stent implantation. A risk score for ST after PCI in ACS can be a helpful tool to personalize risk assessment.
Methods:
This study represents a patient-level pooled analysis of 6,139 patients undergoing PCI with stent implantation for ACS in the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trials who were randomized to treatment with bivalirudin versus heparin plus a glycoprotein IIb/IIIa inhibitor. The cohort was randomly divided into a risk score development cohort (n = 4,093) and a validation cohort (n = 2,046). Cox regression methods were used to identify clinical, angiographic, and procedural characteristics associated with Academic Research Consortium-defined definite/probable ST at 1 year. Each covariate in this model was assigned an integer score based on the regression coefficients.
Results:
Variables included in the risk score were type of ACS (ST-segment elevation myocardial infarction, non-ST-segment elevation ACS with ST deviation, or non-ST-segment elevation ACS without ST changes), current smoking, insulin-dependent diabetes mellitus, prior PCI, baseline platelet count, absence of early (pre-PCI) anticoagulant therapy, aneurysmal/ulcerated lesion, baseline TIMI (Thrombolysis In Myocardial Infarction) flow grade 0/1, final TIMI flow grade <3, and number of treated vessels. Risk scores 1 to 6 were considered low risk, 7 to 9 intermediate risk, and 10 or greater high risk for ST. Rates of ST at 1 year in low-, intermediate-, and high-risk categories were 1.36%, 3.06%, and 9.18%, respectively, in the development cohort (p for trend <0.001), and 1.65%, 2.77%, and 6.45% in the validation cohort (p for trend = 0.006). The C-statistic for this risk score was over 0.65 in both cohorts.
Conclusions:
The individual risk of ST can be predicted using a simple risk score based on clinical, angiographic, and procedural variables. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966) (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACUITY]; NCT00093158).
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