Department of Internal Medicine, Washington Hospital Center, DC, USA.
Am J Cardiol. 2010 Sep 1;106(5):641-5. doi: 10.1016/j.amjcard.2010.04.011.
Clinical and angiographic risk factors associated with adverse outcomes after percutaneous coronary intervention (PCI) have been included in previous validated risk scores. Complications after PCI are known to increase mortality and morbidity but have not been included in any model. Records of 6,932 consecutive patients who underwent PCI from 2000 to 2005 were reviewed. Patients presenting with cardiogenic shock were excluded. Logistic regression and bootstrap methods were used to build an integer risk score for estimating risk of death at 1 year after PCI using baseline, angiographic, and procedural characteristics and postprocedural complications. This risk score was validated in a set of consecutive patients who underwent PCI from 2006 to 2007. The following 8 variables were significantly correlated with outcome: older age, history of diabetes mellitus, chronic renal failure, heart failure, left main coronary artery disease, lower baseline hematocrit, greater hematocrit decrease after PCI, and Thrombolysis In Myocardial Infarction grade <3 flow after PCI. In the validation population (n = 973), average receiver operating characteristic curve area was 0.836. In conclusion, we developed and validated a simple integer risk score, including postprocedural variables that closely predict long-term mortality after PCI. This model emphasizes the significant impact of complications occurring after PCI on long-term outcomes.
经皮冠状动脉介入治疗 (PCI) 后不良结局相关的临床和血管造影危险因素已被纳入之前验证过的风险评分中。尽管 PCI 后的并发症已知会增加死亡率和发病率,但尚未纳入任何模型。本研究回顾了 2000 年至 2005 年期间接受 PCI 的 6932 例连续患者的记录。排除了出现心源性休克的患者。使用逻辑回归和自举方法,基于基线、血管造影和手术特征以及术后并发症,构建了一个整数风险评分,用于估计 PCI 后 1 年死亡风险。该风险评分在 2006 年至 2007 年期间接受 PCI 的另一组连续患者中进行了验证。以下 8 个变量与结局显著相关:年龄较大、糖尿病史、慢性肾衰竭、心力衰竭、左主干冠状动脉疾病、较低的基线红细胞比容、PCI 后红细胞比容下降更大,以及 PCI 后血栓溶解心肌梗死 (TIMI) 分级<3 级血流。在验证人群(n=973)中,平均接收者操作特征曲线面积为 0.836。总之,我们开发并验证了一个简单的整数风险评分,包括术后变量,这些变量可密切预测 PCI 后长期死亡率。该模型强调了 PCI 后发生的并发症对长期结局的重大影响。