Defining Percutaneous Coronary Intervention Complexity and Risk: An Analysis of the United Kingdom BCIS Database
Majd Protty1, Andrew S P Sharp1, Sean Gallagher1
1Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
Insights
This study identified seven patient and six procedural factors associated with increased risk during percutaneous coronary intervention (PCI). A Complex High-Risk Indicated PCI (CHIP) score can help predict adverse outcomes and guide risk modification strategies.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Informatics
Background:
- Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept lacking clear definition.
- Understanding factors contributing to PCI complexity is crucial for patient risk stratification.
Purpose of the Study:
- To define factors associated with percutaneous coronary intervention (PCI) procedural complexity.
- To develop and validate a score for predicting adverse outcomes in complex PCI cases.
Main Methods:
- Utilized the British Cardiovascular Intervention Society (BCIS) database (2006-2016) for UK PCI procedures.
- Developed a multiple logistic regression model to identify variables linked to in-hospital Major Adverse Cardiac or Cerebrovascular Events (MACCE).
- Constructed a CHIP score to quantify procedural complexity and examined its impact on patient outcomes.
Main Results:
- Identified seven patient factors (e.g., age ≥80, prior stroke) and six procedural factors (e.g., rotational atherectomy, left main PCI) as associated with increased MACCE.
- The mean CHIP score increased significantly from 2006 to 2016, with a higher prevalence of high scores.
- In-hospital MACCE demonstrated an exponential increase with rising CHIP scores, from 0.6% (score 0) to 4.4% (score 5+).
Conclusions:
- Seven patient and six procedural factors were defined as CHIP factors, correlating with adverse in-hospital MACCE.
- The developed CHIP score shows potential as a future tool for risk stratification and modification in complex PCI.
Objectives:
The authors used the BCIS (British Cardiovascular Intervention Society) database to define the factors associated with percutaneous coronary intervention (PCI) procedural complexity.
Background:
Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly defined.
Methods:
The BCIS (British Cardiovascular Intervention Society) database was used to study all PCI procedures in the United Kingdom 2006-2016. A multiple logistic regression model was developed to identify variables associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE) and to construct a CHIP score. The cumulative effect of this score on patient outcomes was examined.
Results:
A total of 313,054 patients were included. Seven patient factors (age ≥80 years, female sex, previous stroke, previous myocardial infarction, peripheral vascular disease, ejection fraction <30%, and chronic renal disease) and 6 procedural factors (rotational atherectomy, left main PCI, 3-vessel PCI, dual arterial access, left ventricular mechanical support, and total lesion length >60 mm) were associated with increased in-hospital MACCE and defined as CHIP factors. The mean CHIP score/case for all PCIs increased significantly from 1.06 ± 1.32 in 2006 to 1.49 ± 1.58 in 2016 (P < 0.001 for trend). A CHIP score of 5 or more was present in 2.5% of procedures in 2006 increasing to 5.3% in 2016 (P < 0.001 for trend). Overall in-hospital MACCE was 0.6% when the CHIP score was 0 compared with 1.2% with any CHIP factor present (P < 0.001). As the CHIP score increased, an exponential increase in-hospital MACCE was observed. The cumulative MACCE for procedures associated with a CHIP score 4+ or above was 3.2%, and for a CHIP score 5+ was 4.4%. All other adverse clinical outcomes were more likely as the CHIP score increased.
Conclusions:
Seven patient factors and 6 procedural factors were associated with adverse in-hospital MACCE and defined as CHIP factors. Use of a CHIP score might be a future target for risk modification.
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