Cardiovascular Division, British Heart Foundation Centre of Excellence, St Thomas' Hospital Campus, King's College London, London, United Kingdom.
Am J Cardiol. 2013 Jan 15;111(2):172-7. doi: 10.1016/j.amjcard.2012.09.012. Epub 2012 Oct 24.
Several coronary disease scoring systems have been developed to predict procedural risk during revascularization. Many vary in complexity, do not specifically account for myocardium at risk, and are not applicable across all patient subsets. The British Cardiovascular Intervention Society myocardial jeopardy score (BCIS-JS) addresses these limitations and is applicable to all patients, including those with coronary artery bypass grafts or left main stem disease. We assessed the prognostic relevance of the BCIS-JS in patients undergoing percutaneous coronary intervention (PCI). A total of 663 patients who underwent PCI with previous left ventricular function assessment were retrospectively assessed for inclusion, incorporating 221 with previous coronary artery bypass grafting. Blinded observers calculated the BCIS-JS, before (BCIS-JS(PRE)) and after (BCIS-JS(POST)) PCI, using the revascularization index (RI) (RI = [BCIS-JS(PRE) - BCIS-JS(POST)]/BCIS-JS(PRE)), quantifying the extent of revascularization, 1 indicating full revascularization and 0 indicating no revascularization. The primary end point all-cause mortality, tracked via the Office of National Statistics. A total of 660 patients were included (66 ± 10.7 years), with 43 deaths (6.5%) occurring during 2.6 ± 1.1 years after PCI. All-cause mortality was directly related to BCIS-JS(PRE) (hazard ratio [HR] 2.96, 95% confidence interval [CI] 1.71 to 5.15, p = 0.001) and BCIS-JS(POST) (HR 4.02, 95% CI 2.41 to 6.68, p = 0.001). A RI of <0.67 was associated with increased mortality compared to a RI of ≥0.67 (HR 4.13, 95% CI 1.91 to 8.91, p = 0.0001). On multivariate analysis, a RI <0.67 (HR 1.99, 95% CI 1.03 to 3.87, p = 0.04), left ventricular dysfunction (HR 2.03, 95% CI 1.25 to 3.30, p = 0.004) and renal impairment (HR 3.75, 95% CI 1.48 to 8.64, p = 0.005) were independent predictors of mortality. In conclusion, the BCIS-JS predicts mortality after PCI and can assess the degree of revascularization, with more complete revascularization conferring a survival advantage in the medium term.
已经开发出几种冠状动脉疾病评分系统来预测血运重建过程中的手术风险。许多系统在复杂性、不能专门针对风险心肌以及不适用于所有患者亚组方面存在差异。英国心血管介入学会心肌危险评分（BCIS-JS）解决了这些局限性，适用于所有患者，包括接受冠状动脉旁路移植术或左主干疾病的患者。我们评估了 BCIS-JS 在接受经皮冠状动脉介入治疗（PCI）的患者中的预后相关性。共纳入了 663 名接受 PCI 且既往有左心室功能评估的患者进行回顾性评估，其中包括 221 名接受过冠状动脉旁路移植术的患者。盲法观察者使用血运重建指数（RI）（RI = [BCIS-JS(PRE) - BCIS-JS(POST)]/BCIS-JS(PRE)）计算 BCIS-JS（BCIS-JS(PRE)和 BCIS-JS(POST)），定量评估血运重建程度，1 表示完全血运重建，0 表示未进行血运重建。主要终点是全因死亡率，通过国家统计局进行跟踪。共纳入 660 名患者（66 ± 10.7 岁），PCI 后 2.6 ± 1.1 年期间发生 43 例死亡（6.5%）。全因死亡率与 BCIS-JS(PRE)（风险比 [HR] 2.96，95%置信区间 [CI] 1.71 至 5.15，p = 0.001）和 BCIS-JS(POST)（HR 4.02，95% CI 2.41 至 6.68，p = 0.001）直接相关。与 RI ≥ 0.67 相比，RI <0.67 与死亡率增加相关（HR 4.13，95% CI 1.91 至 8.91，p = 0.0001）。多变量分析显示，RI <0.67（HR 1.99，95% CI 1.03 至 3.87，p = 0.04）、左心室功能障碍（HR 2.03，95% CI 1.25 至 3.30，p = 0.004）和肾功能损害（HR 3.75，95% CI 1.48 至 8.64，p = 0.005）是死亡率的独立预测因素。总之，BCIS-JS 可预测 PCI 后的死亡率，并可评估血运重建程度，更完全的血运重建可在中期提供生存优势。
