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Scoring system predicts risk in patients undergoing PCI or CABG
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Longitudinal risk was predicted by a scoring system that assessed anatomical complexity in patients undergoing revascularization, according to a study published in JAMA Cardiology.
Javier A. Valle, MD, MSCS, interventional cardiologist faculty member at Rocky Mountain Regional Veterans Affairs Medical Center in Aurora, and colleagues analyzed data from 50,226 patients (mean age, 66 years; 98% men) from the VA Clinical Assessment Reporting and Tracking Program who underwent coronary angiography between January 2010 and September 2017. Patients had greater than 50% stenosis in at least one epicardial coronary artery and underwent revascularization by PCI (n = 34,322) or CABG (n = 15,904) within 90 days after angiography.
Researchers calculated an anatomical risk score based on existing registry data, which took into consideration location of stenosis and coronary segment, coronary anatomical dominance, noted calcification or thrombus associated with the lesion, ostial location and bifurcation status.
The primary outcome of intertest was a composite of revascularization, death, rehospitalization for stroke and rehospitalization for MI after the initial revascularization. Secondary endpoints were individual clinical events.
Patients who underwent PCI who were in the highest tertile of anatomical complexity had an increased risk for MACCE compared with those in the lowest tertile (adjusted HR = 2.12; 95% CI, 2.01-2.23). This was not seen in patients who underwent CABG (aHR = 1.04; 95% CI, 0.92-1.17). The adjusted HR for repeat revascularization in patients who underwent CABG was significantly higher in those in the higher tertile of anatomical complexity (aHR = 1.34; 95% CI, 1.06-1.7).
“Implementation of this simplified scoring system may have implications for real-time assessment of procedural risk, with additional potential for refining risk adjustment when evaluating interventional quality in a variety of health care settings,” Valle and colleagues wrote. – by Darlene Dobkowski
Disclosures: Valle reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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