TCT CONNECT-263 A Novel Risk Score to Predict 1-Year Mortality in Patients Undergoing Complex High-Risk Indicated Percutaneous Coronary Intervention (CHIP PCI)

Brener, Sorin J.; Cunn, Gregory; Desai, Pankil; Faroqui, Mouzamjha; Ha, Le Dung; Handa, Garima; Kutkut, Issa; Raza, Ali; Sacchi, Terrence J.

doi:10.1016/j.jacc.2020.09.280

Cited by 8 publications

(16 citation statements)

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“…However, the definition of CHIP was not available in their report 32) . Thus, Brener et al defined CHIP using CHIP criteria such as age, ejection fraction, dialysis, prior bypass surgery, and PCI for left main trunk or CTO or two-vessel disease, and found that CHIP-PCI was associated with increased risk of 1-year mortality 17) . An analysis of the United Kingdom BCIS Database including 313,054 elective PCI found the CHIP factors associated with in-hospital MACCE.…”

Section: Discussionmentioning

confidence: 99%

“…In patients whose baseline CK levels were normal, PMI was defined as an elevation of CK levels twice of the upper limit of normal (ULN) with an elevation of CK-MB levels above the ULN at the next day of patients (CHIP) is an emerging concept in contemporary PCI 16) . CHIP is known to be composed of three factors, namely, (1) patient factors such as frailty or active malignancy, (2) complicated heart disease such as left ventricular dysfunction or severe valvular disease, and (3) complex PCI such as left main disease or CTO [16][17] . Therefore, CHIPpercutaneous coronary intervention (CHIP-PCI) is seen to have more complications as compared to non-CHIP-PCI 18) .…”

Section: Definitionsmentioning

confidence: 99%

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Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

Fujimoto

Sakakura

Jinnouchi

et al. 2023

JAT

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Aims: Complex and high-risk intervention in indicated patients (CHIP) is an emerging concept in the contemporary percutaneous coronary intervention (PCI). CHIP is known to consist three factors, namely, (1) patient factors, (2) complicated heart disease, and (3) complex PCI. However, it remains unclear whether additional CHIP factors further increase the incidence of complications in complex PCI. Thus, in this study, we aim to compare the incidence of complications among definite CHIP, possible CHIP, and non-CHIP in terms of complex PCI and to further investigate the association between CHIP and complications. Methods:The primary aim of this study was to determine the major complications in PCI. We included 989 PCI lesions and divided those into definite CHIP (n=140), possible CHIP (n=397), and the non-CHIP groups (n=452). Results:The incidence of major complications was noted to be the highest in the definite CHIP, followed by the possible CHIP, and lowest in the non-CHIP (p=0.001). The multivariate logistic regression analysis using a generalized estimating equation revealed definite CHIP (versus non-CHIP: odds ratio (OR) 2.099, 95% confidence interval (CI) 1.062-4.150, p=0.033) was significantly associated with major complications after controlling for confounding factors. Another multivariate logistic regression analysis revealed immunosuppressive drugs (OR 3.040, 95% CI 1.251-7.386, p=0.014), unstable hemodynamics (OR 5.753, 95% CI 1.217-27.201, p=0.027), and frailty (OR 2.039, 95% CI 1.108-3.751, p=0.022) were significantly associated with major complications among CHIP factors. Conclusions:The incidence of major complications in complex PCI was determined to be the highest in the definite CHIP, followed by the possible CHIP and lowest in the non-CHIP. Thus, more attention should be given to the three components of CHIP to prevent major complications in complex PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

Fujimoto

Sakakura

Jinnouchi

et al. 2023

JAT

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“…Mortality odds were almost two‐ to threefolds higher in the octogenarians, and trends suggest no change of the same over time; this may relate to age per se. Age has been consistently shown to be an important predictor of adverse outcomes in all contemporary PCI risk scores studied 36–40 . Moreover, one must not forget the effect of unmeasured confounders in the older ager group, such as age‐related physiological changes, frailty, anemia, and poor control of important comorbidities like diabetes that may contribute to the observed high event rates in the octogenarian cohort.…”

Section: Discussionmentioning

confidence: 99%

Complex, high‐risk percutaneous coronary intervention types, trends, and in‐hospital outcomes among different age groups: An insight from a national registry

Shamkhani

Rashid

Mamas

2022

Cathet Cardio Intervent

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Background Complex, high‐risk percutaneous coronary intervention (PCI) (CHiP) is increasingly being undertaken in octogenarians. However, limited data exist on CHiP types, trends, and outcomes in the octogenarian. Methods This is a retrospective cohort study from a national registry dataset on CHiP undertaken in patients with stable angina in England and Wales (January 2006 and December 2017) according to three age groups (group 1 [G1]: < 65 years; group 2 [G2]: 65–79 years; and group 3 [G3]: ≥80 years). Results Of 424,290 elective PCI procedures, 138,831 (33.0%) were CHiP [G1: 46,832 (33.7%); G2: 59,544 (42.9%); G3: 32,455 (23.4%)]. Among CHiP types, chronic total occlusion (CTO) (49.2%), prior coronary artery bypass graft (CABG) (30.4%), and severe vascular calcification (21.8%) were common in G1; prior CABG (42.9%), CTO (32.9%), and severe vascular calcifications (27%) were common in G2; prior CABG (15.8%), severe vascular calcification (15.5%), and chronic renal failure (11.1%) were common CHiP among the octogenarians. The older age groups had higher adjusted odds (aOR) for adverse outcomes [G2: mortality, aOR 1.7, 95% confidence interval (CI): (1.3–2.3); major bleeding, aOR 1.3, 95% CI (1.1–1.5); MACCE, aOR 1.2, 95% CI (1.0–1.3); G3: mortality, aOR 2.6, 95%CI (1.9–3.6); major bleeding, aOR 1.4, 95% CI (1.1–1.7); MACCE, aOR 1.3, 95% CI (1.1–1.5)]. Conclusion There were significant differences in the types of CHiP cases undertaken and clinical outcomes across age groups.

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“… 22 , 24 , 25 In a study of >6000 patients, Brener et al . 5 analysed PCI data and found four criteria for HR-PCI that were significant predictors of mortality. Each of these criteria was assigned points: age >80 years (3 points); dialysis (6 points); LVEF <30% (2 points); and number of lesions treated >2 (2 points).…”

Section: Definition Of High-risk Percutaneous Coronary Interventionmentioning

confidence: 99%

“…4 The 1-year mortality rate of these patients has been shown to range from 1 to 11% due to associated comorbidities. 5 …”

Section: Introductionmentioning

confidence: 99%

Optimized patient selection in high-risk protected percutaneous coronary intervention

Leick

Werner

Panoulas

et al. 2022

European Heart Journal Supplements

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Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients with poor left-ventricular (LV) function undergoing elective high-risk percutaneous coronary interventions (HR-PCIs). These patients are often in critical condition and not suitable candidates for coronary artery bypass graft surgery. For the definition of HR-PCI, there is a growing consensus that multiple factors must be considered to define the complexity of PCI. These include haemodynamic status, left-ventricular ejection fraction, clinical characteristics, and concomitant diseases, as well as the complexity of the coronary anatomy/lesions. Although haemodynamic support by percutaneous LV assist devices is commonly adopted in HR-PCI (protected PCI), there are no clear guideline recommendations for indication due to limited published data. Therefore, decisions to use a nonsurgical, minimally invasive procedure in HR-PCI patients should be based on a risk–benefit assessment by a multidisciplinary team. Here, the current evidence and indications for protected PCI will be discussed.

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TCT CONNECT-263 A Novel Risk Score to Predict 1-Year Mortality in Patients Undergoing Complex High-Risk Indicated Percutaneous Coronary Intervention (CHIP PCI)

Cited by 8 publications

References 0 publications

Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

Complex, high‐risk percutaneous coronary intervention types, trends, and in‐hospital outcomes among different age groups: An insight from a national registry

Optimized patient selection in high-risk protected percutaneous coronary intervention

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