预测慢性完全闭塞性经皮冠状动脉介入治疗围手术期并发症：PROGRESS-CTO并发症评分
Predicting Periprocedural Complications in Chronic Total Occlusion Percutaneous Coronary Intervention: The PROGRESS-CTO Complication Scores.
作者信息
Simsek Bahadir, Kostantinis Spyridon, Karacsonyi Judit, Alaswad Khaldoon, Krestyaninov Oleg, Khelimskii Dmitrii, Davies Rhian, Rier Jeremy, Goktekin Omer, Gorgulu Sevket, ElGuindy Ahmed, Chandwaney Raj H, Patel Mitul, Abi Rafeh Nidal, Karmpaliotis Dimitrios, Masoumi Amirali, Khatri Jaikirshan J, Jaffer Farouc A, Doshi Darshan, Poommipanit Paul B, Rangan Bavana V, Sanvodal Yader, Choi James W, Elbarouni Basem, Nicholson William, Jaber Wissam A, Rinfret Stephane, Koutouzis Michael, Tsiafoutis Ioannis, Yeh Robert W, Burke M Nicholas, Allana Salman, Mastrodemos Olga C, Brilakis Emmanouil S
机构信息
Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
出版信息
JACC Cardiovasc Interv. 2022 Jul 25;15(14):1413-1422. doi: 10.1016/j.jcin.2022.06.007.
BACKGROUND
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with increased risk of periprocedural complications. Estimating the risk of complications facilitates risk-benefit assessment and procedural planning.
OBJECTIVES
This study sought to develop risk scores for in-hospital major adverse cardiovascular events (MACE), mortality, pericardiocentesis, and acute myocardial infarction (MI) in patients undergoing CTO PCI.
METHODS
The study analyzed the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; NCT02061436) and created risk scores for MACE, mortality, pericardiocentesis, and acute MI. Logistic regression prediction modeling was used to identify independently associated variables, and models were internally validated with bootstrapping.
RESULTS
The incidence of periprocedural complications among 10,480 CTO PCIs was as follows: MACE 215 (2.05%), mortality 47 (0.45%), pericardiocentesis 83 (1.08%), and acute MI 66 (0.63%). The final model for MACE included ≥65 years of age (1 point), moderate-severe calcification (1 point), blunt stump (1 point), antegrade dissection and re-entry (ADR) (1 point), female (2 points), and retrograde (2 points); the final model for mortality included ≥65 years of age (1 point), left ventricular ejection fraction ≤45% (1 point), moderate-severe calcification (1 point), ADR (1 point), and retrograde (1 point); the final model for pericardiocentesis included ≥65 years of age (1 point), female (1 point), moderate-severe calcification (1 point), ADR (1 point), and retrograde (2 points); the final model for acute MI included prior coronary artery bypass graft surgery (1 point), atrial fibrillation (1 point), and blunt stump (1 point). The C-statistics of the models were 0.74, 0.80, 0.78, 0.72 for MACE, mortality, pericardiocentesis, and acute MI, respectively.
CONCLUSIONS
The PROGRESS-CTO complication risk scores can facilitate estimation of the periprocedural complication risk in patients undergoing CTO PCI.
背景
慢性完全闭塞病变（CTO）经皮冠状动脉介入治疗（PCI）与围手术期并发症风险增加相关。评估并发症风险有助于进行风险效益评估和手术规划。
目的
本研究旨在为接受CTO PCI的患者制定院内主要不良心血管事件（MACE）、死亡率、心包穿刺术和急性心肌梗死（MI）的风险评分。
方法
该研究分析了PROGRESS-CTO（慢性完全闭塞病变干预研究前瞻性全球注册研究；NCT02061436），并创建了MACE、死亡率、心包穿刺术和急性MI的风险评分。采用逻辑回归预测模型来识别独立相关变量，并通过自抽样法对模型进行内部验证。
结果
10480例CTO PCI患者围手术期并发症的发生率如下：MACE 215例（2.05%），死亡率47例（0.45%），心包穿刺术83例（1.08%），急性MI 66例（0.63%）。MACE的最终模型包括年龄≥65岁（1分）、中度至重度钙化（1分）、钝端（1分）、正向夹层和再入路（ADR）（1分）、女性（2分）和逆向（2分）；死亡率的最终模型包括年龄≥65岁（1分）、左心室射血分数≤45%（1分）、中度至重度钙化（1分）、ADR（1分）和逆向（1分）；心包穿刺术的最终模型包括年龄≥65岁（1分）、女性（1分）、中度至重度钙化（1分）、ADR（1分）和逆向（2分）；急性MI的最终模型包括既往冠状动脉搭桥手术（1分）、心房颤动（1分）和钝端（1分）。MACE、死亡率、心包穿刺术和急性MI模型的C统计量分别为0.74、0.80、0.78、0.72。
结论
PROGRESS-CTO并发症风险评分有助于评估接受CTO PCI患者的围手术期并发症风险。
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