New risk score helps identify high-risk PCI patients
Cardiologists have found that a new risk score is capable of identifying percutaneous coronary intervention (PCI) patients who may face a higher risk of complications, sharing their findings in the American Journal of Cardiology.[1]
“Patients with coronary artery disease (CAD) at higher risk of adverse events after PCI because of co-morbidities, poor hemodynamics, and/or complex coronary anatomy represent a vulnerable, understudied, and growing population,” wrote corresponding author Roxana Mehran, MD, an interventional cardiologist with the Icahn School of Medicine at Mount Sinai, and colleagues. “There is no universally accepted definition for patients at higher risk of complications after PCI. Several scores or criteria have been proposed to estimate the patient's risk for adverse events. Nevertheless, some of those cannot be easily implemented in clinical practice because they rely on complex calculations or on a large number of variables; others do not predict risk accurately, because they take into account exclusively clinical or angiographic features.”
Mehran et al. aimed to validate a recently proposed risk score for one-year mortality after PCI, focusing on data from more than 12,000 patients who were treated at a single high-volume hospital from January 2014 to December 2019. All patients presented with stable ischemic heart disease or non–ST-elevation acute coronary syndrome (NSTE-ACS). In cases of acute ST-elevation myocardial infarction or cardiogenic shock, the patients were excluded.
The risk score at the center of the team’s analysis focused on the presence of a certain variables, including an age of 80 years old or older, chronic kidney disease, dialysis, left ventricular ejection fraction (LVEF) lower than 30% and multivessel PCI. This risk score was used to separate patients into three different groups: low-risk patients, intermediate-risk patients and high-risk patients. Patients were then followed for one year after the procedure.
Overall, 5.4% of patients were found to be at a high risk. An additional 16.7% of patients were found to be at an intermediate risk, and the remaining patients were all found to be at a low risk.
Patients in the intermediate- and high-risk groups were older than patients in the low-risk group. They were also more likely to be female and more likely to present with almost all co-morbidities that the researchers tracked—the exceptions were smoking and a high body mass index, which were more common among low-risk patients. In addition, patients in the intermediate- and high-risk groups were more likely to be discharged on oral anticoagulant therapy or clopidogrel. Low-risk patients, meanwhile, were more likely to be treated with dual antiplatelet therapy that included a P2Y12-inhibitor.
The risk score was able to effectively anticipate which patients may face an increased risk of post-PCI complications. Patients in the high-risk group, for example, faced a risk of all-cause one-year mortality that was nine times higher than patients in the low-risk group. Patients in the intermediate-risk group, meanwhile, faced a risk of all-cause one-year mortality that was four times higher than patients in the low-risk group.
In addition, the authors found, the risk of major adverse cardiovascular events and major bleeding events increased from the low-risk group to the high-risk group.
“This risk assessment tool could be implemented in clinical practice and used in future trials to select participants with complex or high-risk CAD,” the authors wrote.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.