Professor of Medicine, Director, Cardiac Catheterization Laboratory, New York Methodist Hospital, 506 6th Street, KP-2, Brooklyn, NY 11215 USA.
J Invasive Cardiol. 2021 Apr;33(4):E253-E258. doi: 10.25270/jic/20.00515. Epub 2021 Feb 4.
To identify patients undergoing complex, high-risk indicated percutaneous coronary intervention (CHIP-PCI) and compare their outcomes with non-CHIP patients. We created a CHIP score to risk stratify these patients.
Risk stratification of PCI patients remains difficult because most scoring systems reflect hemodynamic instability and predict early mortality.
CHIP-PCI was defined as any of the following: age >80 years; ejection fraction <30%; dialysis; prior bypass surgery; treatment of left main trunk; chronic total occlusion; or >2 lesions in >1 coronary artery. The primary endpoint was 1-year all-cause mortality. Logistic regression identified independent predictors of 1-year mortality and the odds ratios (ORs) for those predictors were used to create a CHIP score. Patients were then classified as low, intermediate, and high risk.
Among 4478 patients, a total of 1730 (38.6%) were CHIP. There were 85 deaths (2.2%) at 1 year (4.1% in CHIP patients and 1.0% in non-CHIP patients; P<.001). CHIP-PCI was an independent predictor of mortality (OR, 2.57; 955 confidence interval, 1.52-4.32; P<.001). Four CHIP criteria were independent predictors of mortality: age >80 years (3 points); dialysis (6 points); ejection fraction <30% (2 points); and number of lesions treated >2 (2 points). Accordingly, there were 2752 low-risk (score of 0), 889 intermediate-risk (score of 2-3), and 267 high-risk patients (score of 4-13). The 1-year mortality rates among these 3 groups were 1.24%, 2.47%, and 10.86%, respectively (P<.001).
Compared with non-CHIP, CHIP-PCI is associated with increased risk of 1-year mortality, which is particularly evident among those fulfilling >1 CHIP criterion.
确定接受复杂高危指征性经皮冠状动脉介入治疗（CHIP-PCI）的患者，并将其与非-CHIP 患者的结局进行比较。我们创建了一个 CHIP 评分来对这些患者进行风险分层。
PCI 患者的风险分层仍然很困难，因为大多数评分系统反映的是血流动力学不稳定，并预测早期死亡率。
CHIP-PCI 定义为以下任何一种情况：年龄>80 岁；射血分数<30%；透析；既往旁路手术；左主干治疗；慢性完全闭塞；或>1 条冠状动脉中有>2 处病变。主要终点为 1 年全因死亡率。逻辑回归确定了 1 年死亡率的独立预测因素，并用这些预测因素的比值比（OR）来创建 CHIP 评分。然后，患者被分为低危、中危和高危。
在 4478 名患者中，共有 1730 名（38.6%）为 CHIP。1 年内有 85 例死亡（CHIP 患者为 4.1%，非 CHIP 患者为 1.0%；P<.001）。CHIP-PCI 是死亡率的独立预测因素（OR，2.57；95%置信区间，1.52-4.32；P<.001）。四项 CHIP 标准是死亡率的独立预测因素：年龄>80 岁（3 分）；透析（6 分）；射血分数<30%（2 分）；以及治疗的病变数>2（2 分）。因此，有 2752 名低危患者（评分 0）、889 名中危患者（评分 2-3）和 267 名高危患者（评分 4-13）。这 3 组患者的 1 年死亡率分别为 1.24%、2.47%和 10.86%（P<.001）。
与非-CHIP 相比，CHIP-PCI 与 1 年死亡率增加相关，尤其是在满足>1 项 CHIP 标准的患者中更为明显。
