Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
JACC Cardiovasc Interv. 2023 May 8;16(9):1011-1020. doi: 10.1016/j.jcin.2023.02.005.
A complex high-risk indicated percutaneous coronary intervention (CHIP) score was recently developed from the British Cardiovascular Intervention Society (BCIS) database to define CHIP cases and their risk of in-hospital major adverse cardiac or cerebrovascular events (MACCE).
The authors sought to apply this score to a contemporary U.S. population for the prediction of adverse events at 1 year following percutaneous coronary intervention (PCI).
Consecutive patients undergoing PCI at a large tertiary care center between 2011 and 2020 were considered for inclusion. Patients were categorized into 4 groups based on their BCIS-CHIP score (0, 1-2, 3-4, ≥5). In each category, we assessed the 1-year risk of MACCE, a composite of all-cause death, myocardial infarction, and stroke. Secondary outcomes were the individual components of MACCE, and major bleeding at 1 year.
Among 20,799 patients included, MACCE at 1 year occurred in 1.7% patients with score 0 (reference), 3.0% with score 1 or 2 (HR: 1.72; 95% CI: 1.32-2.24), 6.1% with score 3 or 4 (HR: 3.60; 95% CI: 2.78-4.66), and 12.0% with score ≥5 (HR: 7.40; 95% CI: 5.75-9.51). Each point increase of the BCIS-CHIP score conferred a 28.0% increase of MACCE risk. The BCIS-CHIP score demonstrated good discrimination for the prediction of 1-year MACCE (C-index 0.70). The risk of secondary outcomes also progressively increased with higher score values.
In a large PCI registry, the BCIS-CHIP score had a good predictive value for MACCE at 1 year. The utilization of this score can facilitate an accurate risk stratification of patients undergoing PCI.
最近从英国心血管介入学会（BCIS）数据库中开发了一种复杂的高风险经皮冠状动脉介入治疗（CHIP）评分，用于定义 CHIP 病例及其住院期间主要不良心脏或脑血管事件（MACCE）的风险。
作者试图将该评分应用于当代美国人群，以预测经皮冠状动脉介入治疗（PCI）后 1 年的不良事件。
连续纳入 2011 年至 2020 年在一家大型三级护理中心接受 PCI 的患者进行研究。根据 BCIS-CHIP 评分（0、1-2、3-4、≥5）将患者分为 4 组。在每个类别中，我们评估了 MACCE 的 1 年风险，即全因死亡、心肌梗死和中风的综合结果。次要结局为 MACCE 的各个组成部分，以及 1 年时的主要出血。
在纳入的 20799 例患者中，1 年时发生 MACCE 的患者占 1.7%（评分 0，参考），评分 1 或 2 的患者占 3.0%（HR：1.72；95%CI：1.32-2.24），评分 3 或 4 的患者占 6.1%（HR：3.60；95%CI：2.78-4.66），评分≥5 的患者占 12.0%（HR：7.40；95%CI：5.75-9.51）。BCIS-CHIP 评分每增加 1 分，MACCE 风险增加 28.0%。BCIS-CHIP 评分对 1 年 MACCE 的预测具有良好的区分度（C 指数 0.70）。随着评分值的升高，次要结局的风险也逐渐增加。
在一项大型 PCI 注册研究中，BCIS-CHIP 评分对 1 年 MACCE 有较好的预测价值。该评分的应用可以为接受 PCI 的患者进行准确的风险分层。
