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Published on: August 28, 2018
Angiographic Lesion Complexity Score and In-Hospital Outcomes after Percutaneous Coronary Intervention
Ayaka Endo1, Akio Kawamura2, Hiroaki Miyata3
1Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Insights
A new scoring system for percutaneous coronary intervention (PCI) effectively predicts in-hospital complications. This complexity score helps identify patients at higher risk for adverse events following PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) is increasingly used for coronary artery disease.
- Lesion complexity during PCI is a known risk factor for in-hospital complications.
Purpose of the Study:
- To develop a scoring system for PCI based on angiographic lesion complexity.
- To evaluate the association between this complexity score and in-hospital complications.
Main Methods:
- A scoring system was devised using data from 3692 PCI patients.
- Complexity was defined by bifurcation, chronic total occlusion, type C, and left main lesions, plus acute thrombus in ST-elevation myocardial infarction.
- Each variable contributed one point to the score.
Main Results:
- 60.1% of patients had at least one complex lesion.
- Higher risk score groups were older and had higher rates of in-hospital death, heart failure, cardiogenic shock, significant bleeding, and myocardial infarction.
- The association between the score and adverse outcomes remained significant after adjusting for clinical predictors (OR 1.72, p < 0.001).
Conclusions:
- The developed complexity score is cumulatively associated with in-hospital mortality and complication rates.
- This scoring system can be utilized for predicting adverse events in patients undergoing PCI.
Objective:
We devised a percutaneous coronary intervention (PCI) scoring system based on angiographic lesion complexity and assessed its association with in-hospital complications.
Background:
Although PCI is finding increasing application in patients with coronary artery disease, lesion complexity can lead to in-hospital complications.
Methods:
Data from 3692 PCI patients were scored based on lesion complexity, defined by bifurcation, chronic total occlusion, type C, and left main lesion, along with acute thrombus in the presence of ST-segment elevation myocardial infarction (1 point assigned for each variable).
Results:
The patients' mean age was 67.5 +/- 10.8 years; 79.8% were male. About half of the patients (50.3%) presented with an acute coronary syndrome, and 2218 (60.1%) underwent PCI for at least one complex lesion. The patients in the higher-risk score groups were older (p < 0.001) and had present or previous heart failure (p = 0.02 and p = 0.01, respectively). Higher-risk score groups had significantly higher in-hospital event rates for death, heart failure, and cardiogenic shock (from 0 to 4 risk score; 1.7%, 4.5%, 6.3%, 7.1%, 40%, p < 0.001); bleeding with a hemoglobin decrease of >3.0 g/dL (3.1%, 11.0%, 13.1%, 10.3%, 28.6%, p < 0.001); and postoperative myocardial infarction (1.5%, 3.1%, 3.8%, 3.8%, 10%, p = 0.004), respectively. The association with adverse outcomes persisted after adjustment for known clinical predictors (odds ratio 1.72, p < 0.001).
Conclusion:
The complexity score was cumulatively associated with in-hospital mortality and complication rate and could be used for event prediction in PCI patients.
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