Tenaglia A N, Fortin D F, Califf R M, Frid D J, Nelson C L, Gardner L, Miller M, Navetta F I, Smith J E, Tcheng J E
Tulane University Medical Center, New Orleans, Louisiana.
J Am Coll Cardiol. 1994 Oct;24(4):1004-11. doi: 10.1016/0735-1097(94)90862-1.
We proposed to examine the relation between angiographic morphologic characteristics and abrupt closure after coronary angioplasty and to develop an empirically based risk stratification system.
Certain lesion morphologic characteristics are associated with higher rates of abrupt closure after coronary angioplasty. Previous approaches have been limited by relatively small sample sizes and an inability to combine multiple characteristics to predict risk in an individual patient.
Lesion morphology was determined for 779 lesions in 658 patients undergoing an elective first angioplasty. Abrupt closure occurred in 63 lesions (8.1%). Variables associated with abrupt closure were identified by univariate and stepwise multiple logistic regression analysis, and internal validity was assessed by use of bootstrapping. An empirically based scoring system was developed by assigning different weights to each predictive characteristic and was then validated.
Almost all lesion characteristics previously labeled "adverse" were associated with an increased risk of abrupt closure, but only total occlusion, location at a branch point, increasing lesion length, evidence for thrombus and right coronary artery location were statistically significant independent predictors. Despite the large sample size, the study was underpowered to detect even a 50% increase in risk with many characteristics. Using a scoring system, we assigned each lesion a specific risk of abrupt closure. The distribution of risk was broad, with 20% of patients having < or = 2.5% risk and 25% having > 10% risk. Internal validation techniques revealed that when 10% of patients were randomly eliminated from the sample in multiple iterations, the risk estimates varied, again pointing to the need for a larger sample.
Empirically based weighting of lesion characteristics could quantify the risk of abrupt closure for individual patients, but a very large sample will be required to understand the interplay of complex lesion characteristics in altering expected outcomes.
我们旨在研究冠状动脉血管成形术后血管造影形态学特征与急性血管闭塞之间的关系，并建立一个基于经验的风险分层系统。
某些病变形态学特征与冠状动脉血管成形术后较高的急性血管闭塞发生率相关。以往的方法因样本量相对较小以及无法综合多种特征来预测个体患者的风险而受到限制。
对658例行择期首次血管成形术患者的779处病变进行了病变形态学评估。63处病变（8.1%）发生了急性血管闭塞。通过单因素和逐步多因素逻辑回归分析确定与急性血管闭塞相关的变量，并使用自抽样法评估内部效度。通过给每个预测特征赋予不同权重建立了一个基于经验的评分系统，随后对其进行验证。
几乎所有先前被标记为“不良”的病变特征都与急性血管闭塞风险增加相关，但只有完全闭塞、分支点位置、病变长度增加、血栓形成证据以及右冠状动脉位置是具有统计学意义的独立预测因素。尽管样本量很大，但该研究仍缺乏足够的效力来检测许多特征导致的风险即使增加50%的情况。使用评分系统，我们为每个病变赋予了特定的急性血管闭塞风险。风险分布范围很广，20%的患者风险≤2.5%，25%的患者风险>10%。内部验证技术显示，在多次迭代中从样本中随机剔除10%的患者时，风险估计值会有所不同，这再次表明需要更大的样本量。
基于经验对病变特征进行加权可以量化个体患者急性血管闭塞的风险，但需要非常大的样本量才能理解复杂病变特征在改变预期结果中的相互作用。
