Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
Department of Cardiology, St Georges Hospital, London, United Kingdom.
JACC Cardiovasc Interv. 2022 Jan 10;15(1):39-49. doi: 10.1016/j.jcin.2021.09.039.
The authors used the BCIS (British Cardiovascular Intervention Society) database to define the factors associated with percutaneous coronary intervention (PCI) procedural complexity.
Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly defined.
The BCIS (British Cardiovascular Intervention Society) database was used to study all PCI procedures in the United Kingdom 2006-2016. A multiple logistic regression model was developed to identify variables associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE) and to construct a CHIP score. The cumulative effect of this score on patient outcomes was examined.
A total of 313,054 patients were included. Seven patient factors (age ≥80 years, female sex, previous stroke, previous myocardial infarction, peripheral vascular disease, ejection fraction <30%, and chronic renal disease) and 6 procedural factors (rotational atherectomy, left main PCI, 3-vessel PCI, dual arterial access, left ventricular mechanical support, and total lesion length >60 mm) were associated with increased in-hospital MACCE and defined as CHIP factors. The mean CHIP score/case for all PCIs increased significantly from 1.06 ± 1.32 in 2006 to 1.49 ± 1.58 in 2016 (P < 0.001 for trend). A CHIP score of 5 or more was present in 2.5% of procedures in 2006 increasing to 5.3% in 2016 (P < 0.001 for trend). Overall in-hospital MACCE was 0.6% when the CHIP score was 0 compared with 1.2% with any CHIP factor present (P < 0.001). As the CHIP score increased, an exponential increase in-hospital MACCE was observed. The cumulative MACCE for procedures associated with a CHIP score 4+ or above was 3.2%, and for a CHIP score 5+ was 4.4%. All other adverse clinical outcomes were more likely as the CHIP score increased.
Seven patient factors and 6 procedural factors were associated with adverse in-hospital MACCE and defined as CHIP factors. Use of a CHIP score might be a future target for risk modification.
作者利用英国心血管介入学会（BCIS）数据库定义与经皮冠状动脉介入治疗（PCI）手术复杂性相关的因素。
高风险经皮冠状动脉介入治疗（CHIP-PCI）是一个新兴概念，目前尚未得到很好的定义。
利用 BCIS 数据库研究了 2006 年至 2016 年英国所有的 PCI 手术。建立了多变量逻辑回归模型，以确定与住院期间主要不良心脏或脑血管事件（MACCE）相关的变量，并构建 CHIP 评分。分析该评分对患者结局的累积影响。
共纳入 313054 例患者。7 项患者因素（年龄≥80 岁、女性、既往卒中、既往心肌梗死、外周血管疾病、射血分数<30%和慢性肾脏疾病）和 6 项手术相关因素（旋磨术、左主干 PCI、三血管 PCI、双动脉入路、左心室机械支持和总病变长度>60mm）与住院期间 MACCE 增加相关，被定义为 CHIP 因素。所有 PCI 的平均 CHIP 评分/例数从 2006 年的 1.06±1.32 显著增加至 2016 年的 1.49±1.58（趋势 P<0.001）。2006 年 2.5%的手术中 CHIP 评分为 5 分或更高，2016 年增加至 5.3%（趋势 P<0.001）。CHIP 评分为 0 时，住院期间总 MACCE 为 0.6%，而任何 CHIP 因素存在时为 1.2%（P<0.001）。随着 CHIP 评分的增加，住院期间 MACCE 呈指数增加。CHIP 评分 4+或更高的手术累积 MACCE 为 3.2%，CHIP 评分 5+为 4.4%。随着 CHIP 评分的增加，其他所有不良临床结局发生的可能性也随之增加。
7 项患者因素和 6 项手术相关因素与住院期间不良 MACCE 相关，被定义为 CHIP 因素。使用 CHIP 评分可能是未来风险修正的目标。
