Comparison of six risk scores in patients with triple vessel coronary artery disease undergoing PCI: Competing factors influence mortality, myocardial infarction, and target lesion revascularization

Abstract

Objectives To compare the discriminatory value of differing risk scores for predicting clinical outcomes following PCI in routine practice. Background Various risk scores predict outcomes after PCI. However, these scores consider markedly different factors, from purely anatomical (SYNTAX risk score [SRS]) to purely clinical (ACEF, modified ACEF [ACEFmod], NCDR), while other scores combine both elements (Clinical SYNTAX score [CSS], NY State Risk Score [NYSRS]). Methods Patients with triple vessel and/or LM disease with 12 month follow-up were studied from a single center PCI registry. Exclusion criteria included STEMI presentation, prior revascularization and shock. Clinical events at 12 months were compared to baseline risk scores, according to score tertiles and area under receiver-operating-characteristic curves (AUC). Results We identified 584 eligible patients (69.8±12.3yrs, 405 males). All scores were predictive of mortality, with the SRS being least predictive (AUC=0.66). The most accurate scores for mortality were the CSS and ACEF (AUC=0.76 for both: p=0.019 and 0.08 vs. SRS, respectively). For TLR, while the SRS trended toward being positively predictive (p=0.075), several scores trended towards a negative association, which reached significance for the NCDR (p=0.045). The SRS and CSS were the only scores predictive of MI (both p<0.05). No score was particularly accurate for predicting MACE (death+MI+TLR), with AUCs ranging from 0.53 (NCDR) to 0.63 (SRS). Conclusions Competing factors influence mortality, MI and TLR after PCI. An increasing burden of comorbidities is associated with mortality, whereas anatomical complexity predicts MI. By combining these outcomes to predict MACE, all scores show reduced utility.

Precision Medicine at the University of Alabama at Birmingham: Laying the Foundational Processes Through Implementation of Genotype‐Guided Antiplatelet Therapy

“…High‐risk patients included patients with ACS and high‐risk PCI patients (e.g., bifurcation site PCI, multivessel PCI, history of adverse outcome) as reported in the ACCF/AHA recommendations . There are several prediction models that identify patients at high risk for poor outcomes among ACS/PCI patients. Interventionists usually consider patients with multiple risk factors and those with bifurcation site PCI or multivessel PCI as high risk.…”

New vessel formation in the context of cardiomyocyte regeneration – the role and importance of an adequate perfusing vasculature

“…bypass graft surgery or angioplasty with stenting). 36 The SYNTAX score is calculated for each patient based on the location, complexity, and characteristics of their coronary atherosclerotic lesions. 37 As highlighted by Head et al, one of the principal aspects of the SYNTAX score is that it estimates the extent of ischemic myocardium.…”

“…38 Our group has shown, as have many others, that with an increasing number of lesions and their complexity, greater SYNTAX scores are related to worse clinical outcomes including MI and death. 36 In other words, clinical outcomes are related to the complexity and burden of CAD (as classified by the SYNTAX score) and the extent of myocardial ischemia.…”

Patients with 3‐Vessel Coronary Artery Disease and Impaired Ventricular Function Undergoing PCI with Impella 2.5 Hemodynamic Support Have Improved 90‐Day Outcomes Compared to Intra‐Aortic Balloon Pump: A Sub‐Study of The PROTECT II Trial

“…To investigate these specific scenarios, the PROTECT II study incorporated pre‐specified stratified enrollment based on coronary anatomy, with patients stratified into either the 3‐vessel disease (3VD) subgroup (presented here), or a second subgroup comprising patients with either left main disease or only a single remaining patent vessel, with randomization to IR2.5 or IABP being performed separately within those sub‐groups. Importantly, there is now heightened interest surrounding these sub‐groups, due to both a rapidly growing appreciation of the complexities of predicting post‐PCI outcomes, as well as differences with respect to the use of rotational atherectomy among the IR2.5 versus IABP groups in PROTECT II …”