Krone R J, Laskey W K, Johnson C, Kimmel S E, Klein L W, Weiner B H, Cosentino J J, Johnson S A, Babb J D
Department of Medicine, Washington University, St. Louis, Missouri 63110-1093, USA.
Am J Cardiol. 2000 May 15;85(10):1179-84. doi: 10.1016/s0002-9149(00)00724-4.
In 1988, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures presented a classification of coronary lesions utilizing 26 lesion features to predict the success and complications of balloon angioplasty. Using data from the Registry of the Society for Cardiac Angiography and Interventions (SCAI) we evaluated the ability of this classification to predict success and complications. Lesion success, death in hospital, emergency cardiac bypass surgery, and major adverse events were evaluated in 41,071 patients who underwent single-vessel angioplasty from January 1993 to June 1996. Logistic models using the ACC/AHA lesion classification, vessel patency, or both, were compared. A new classification based on the interaction of the ACC/AHA classification plus lesion patency was compared with the existing ACC/AHA classification. Vessel patency, added to the ACC/AHA classification, improved prediction of lesion success (p </=0.0001). Class A and patent B lesions had similar success and complication rates, so a simplified classification (SCAI) using only 7 lesion characteristics could be created. This system (I: non-C patent, II: C patent, III: non-C occluded, and IV: C occluded) improved prediction of lesion success compared with the ACC/AHA classification (Bayesian Information Criterion statistic: ACC/AHA 16539, SCAI 15956; and area under the receiver- operating characteristics curve 0.659, 0.693, respectively). The SCAI classification was preferred for predicting major complications and in-hospital death and was similar to the ACC/AHA classification for predicting emergency bypass surgery.
1988年，美国心脏病学会/美国心脏协会（ACC/AHA）心血管诊断和治疗程序评估特别工作组提出了一种利用26个病变特征对冠状动脉病变进行分类的方法，以预测球囊血管成形术的成功率和并发症。我们使用心脏血管造影和介入学会（SCAI）注册中心的数据，评估了这种分类方法预测成功率和并发症的能力。对1993年1月至1996年6月期间接受单支血管成形术的41071例患者的病变成功率、住院死亡、急诊心脏搭桥手术和主要不良事件进行了评估。比较了使用ACC/AHA病变分类、血管通畅情况或两者的逻辑模型。将基于ACC/AHA分类与病变通畅情况相互作用的新分类与现有的ACC/AHA分类进行了比较。将血管通畅情况添加到ACC/AHA分类中，可改善对病变成功率的预测（p≤0.0001）。A类病变和通畅的B类病变具有相似的成功率和并发症发生率，因此可以创建一种仅使用7个病变特征的简化分类（SCAI）。与ACC/AHA分类相比，该系统（I：非C型通畅，II：C型通畅，III：非C型闭塞，IV：C型闭塞）改善了对病变成功率的预测（贝叶斯信息准则统计量：ACC/AHA为16539，SCAI为15956；受试者操作特征曲线下面积分别为0.659、0.693）。SCAI分类在预测主要并发症和住院死亡方面更具优势，在预测急诊搭桥手术方面与ACC/AHA分类相似。
