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Outcomes Prediction in Complex High-Risk Indicated Percutaneous Coronary Interventions in the Older Patients

Alexander Marschall1, David Martí Sánchez1, José Luis Ferreiro2

  • 1Department of Cardiology, Central Defense Hospital Gómez Ulla, Madrid, Spain; University of Alcalá, Madrid, Spain.

The American Journal of Cardiology
|September 4, 2023
PubMed

Insights

The Complex High-Risk Percutaneous Coronary Intervention (CHIP-PCI) score predicts in-hospital events in elderly patients but has limited 1-year predictive value. A modified score including additional factors significantly improves risk prediction.

Area of Science:

  • Cardiology
  • Geriatrics
  • Interventional Cardiology

Background:

  • Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is not well-defined or validated in elderly populations.
  • Risk stratification is crucial for managing percutaneous coronary intervention (PCI) in older adults.

Purpose of the Study:

  • To evaluate the predictive accuracy of the CHIP-PCI score in patients aged 75 years and older.
  • To identify additional risk factors for major adverse cardiac and cerebrovascular events (MACCEs) in this demographic.
  • To develop an improved risk prediction model for elderly patients undergoing PCI.

Main Methods:

  • Pooled analysis of 2,725 patients (≥75 years) from three registries (2012-2019).
  • Evaluation of the original CHIP-PCI score variables and identification of additional predictors for 1-year and in-hospital MACCEs.
  • Comparison of the discriminatory performance of the original and a modified CHIP-PCI score using area under the curve (AUC).

Main Results:

  • The original CHIP-PCI score showed predictive value for in-hospital MACCEs (AUC 0.657) but limited value for 1-year MACCEs (AUC 0.598).
  • Independent predictors for 1-year MACCEs included previous myocardial infarction, low ejection fraction, chronic kidney disease, left main PCI, and nonradial access.
  • Diabetes mellitus, anemia, and severe calcification were also significant predictors.
  • The modified CHIP-PCI score (including 5 patient-related and 3 procedure-related factors) significantly improved discrimination for both in-hospital (AUC 0.729) and 1-year MACCEs (AUC 0.647).

Conclusions:

  • The CHIP-PCI score maintains prognostic value for in-hospital MACCEs in elderly patients.
  • The original CHIP-PCI score has limited predictive value for 1-year MACCEs in this population.
  • A modified CHIP-PCI score incorporating additional patient and procedural factors significantly enhances risk prediction accuracy for elderly patients undergoing PCI.

Keywords:
CHIP-PCIelderlyoutcomes

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