预测复杂的高风险指标皮肤冠状动脉干预在老年患者的结果
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
概括
复杂高风险皮肤冠状动脉干预 (CHIP-PCI) 评分预测老年患者的住院事件,但具有有限的1年预测价值. 包括额外因素在内的修改得分显著改善了风险预测.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 干预心脏病学 干预心脏病学
背景情况:
- 在老年人群中,复杂的高风险指定的皮肤穿透冠状动脉干预 (CHIP-PCI) 尚未明确或验证.
- 风险分层对于老年人皮肤冠状动脉干预 (PCI) 的管理至关重要.
研究的目的:
- 评估75岁及以上患者CHIP-PCI得分的预测准确性.
- 在这个人口群体中确定主要不良心脏和脑血管事件 (MACCE) 的额外危险因素.
- 为接受PCI的老年患者开发一个改进的风险预测模型.
主要方法:
- 从三个注册表 (2012-2019) 中对2,725名患者 (≥75岁) 的综合分析.
- 评估最初的CHIP-PCI得分变量,并确定1年和住院MACCE的额外预测因素.
- 使用曲线下面面积 (AUC) 的原始和修改的CHIP-PCI得分的歧视性表现的比较.
主要成果:
- 最初的CHIP-PCI得分显示了住院MACCE的预测值 (AUC0.657),但对1年的MACCE的预测值有限 (AUC0.598).
- 一年内MACCE的独立预测因素包括先前的心肌梗塞,低射出分数,慢性脏病,左主PCI和非辐射接入.
- 糖尿病,贫血和严重化也是重要的预测因素.
- 修改后的CHIP-PCI得分 (包括5个与患者相关的和3个与程序相关的因素) 显著改善了住院 (AUC 0.729) 和1年的MACCE (AUC 0.647) 的歧视.
结论:
- CHIP-PCI得分保持了老年患者住院MACCE的预后价值.
- 最初的CHIP-PCI得分对该人群中的1年MACCEs具有有限的预测价值.
- 修改后的CHIP-PCI得分包含了额外的患者和程序因素,显著提高了接受PCI的老年患者的风险预测准确度.
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