A Novel Risk Score to Predict One-Year Mortality in Patients Undergoing Complex High-Risk Indicated Percutaneous...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Outcomes Research

Background:

• Risk stratification for percutaneous coronary intervention (PCI) is challenging, with existing systems often focusing on hemodynamic instability and short-term mortality.
• Identifying patients undergoing complex, high-risk indicated percutaneous coronary intervention (CHIP-PCI) is crucial for understanding and improving outcomes.

Purpose of the Study:

• To identify patients undergoing CHIP-PCI.
• To compare outcomes between CHIP-PCI and non-CHIP patients.
• To develop and validate a risk stratification score (CHIP score) for CHIP-PCI patients.

Main Methods:

• Defined CHIP-PCI based on criteria including age >80, ejection fraction <30%, dialysis, prior bypass surgery, left main trunk treatment, chronic total occlusion, or >2 lesions in >1 coronary artery.
• Utilized logistic regression to identify independent predictors of 1-year all-cause mortality.
• Developed a CHIP score using odds ratios of predictors and classified patients into low, intermediate, and high-risk groups.

Main Results:

• Out of 4478 patients, 1730 (38.6%) were classified as CHIP-PCI.
• One-year all-cause mortality was significantly higher in CHIP-PCI patients (4.1%) compared to non-CHIP patients (1.0%; P<.001).
• The CHIP score effectively stratified risk, with 1-year mortality rates of 1.24% (low-risk), 2.47% (intermediate-risk), and 10.86% (high-risk; P<.001).

Conclusions:

• CHIP-PCI is associated with a substantially increased risk of 1-year mortality compared to non-CHIP procedures.
• The developed CHIP score, based on key risk factors like age, dialysis, ejection fraction, and lesion complexity, provides effective risk stratification for CHIP-PCI patients.
• This risk stratification is particularly important for patients with multiple CHIP criteria, highlighting the need for tailored management strategies.