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Canadian Journal of Cardiology

Validating the Performance of 5 Risk Scores for Major Adverse Cardiac Events in Patients Who Achieved Complete Revascularization After Percutaneous Coronary Intervention

  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Dong Zhang
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Ruohua Yan
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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  • Guofeng Gao
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Hao Wang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Rui Fu
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Jia Li
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Dong Yin
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Chenggang Zhu
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Lei Feng
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Weihua Song
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Bo Xu
    Correspondence
    Dr Bo Xu, Fuwai Hospital, National Center for Cardiovascular Diseases, A 167, Beilishi Road, Xicheng District, Beijing, 100037, China. Tel.: +86-10-8832-2562.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Kefei Dou
    Correspondence
    Corresponding authors: Dr Kefei Dou, Fuwai Hospital, National Center for Cardiovascular Diseases, A 167, Beilishi Road, Xicheng District, Beijing, 100037, China. Tel.: +86-10-8839-6590.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Yuejin Yang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
Published:February 26, 2019DOI:https://doi.org/10.1016/j.cjca.2019.02.017

      Abstract

      Background

      Risk scores, like the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (SS), clinical SS, logistic SS (core model and extended model [LSSextended]), Age, Creatinine, and Ejection Fraction (ACEF) score, and modified ACEF score, are predictive for major adverse cardiac events (MACE; including all-cause mortality, myocardial infarction [MI], and revascularization) in patients who have undergone percutaneous coronary intervention (PCI). However, few studies have validated the performance of these scores in complete revascularization (CR) patients. We aimed to compare the performance of previous risk scores in patients who achieved CR after PCI.

      Methods

      All patients (N = 10,724) who underwent PCI at Fuwai Hospital in 2013 were screened, and those who achieved CR after PCI were enrolled. Risk scores were calculated by experienced cardiologists blinded to the clinical outcomes. Discrimination of risk scores was assessed according to the area under the receiver operating characteristic curve (AUC).

      Results

      Fifty-one percent (5375/10,724) of patients who underwent PCI achieved CR. At a mean follow-up of 2.4 years, the mortality, MI, revascularization, and MACE rates were 1.2%, 1.0%, 6.3%, and 7.7%, respectively. SS was not predictive for mortality (AUC, 0.51; 95% confidence interval [CI], 0.44-0.59). All scores involving clinical variables, especially modified ACEF score (AUC, 0.73; 95% CI, 0.66-0.79), could predict mortality. LSSextended was the most accurate for MI (AUC, 0.68; 95% CI, 0.61-0.75). SS and LSSextended were predictive for revascularization, with marginally significant AUCs (SS, 0.54; LSSextended, 0.55). No score was particularly accurate for predicting MACE, with AUCs ranging from 0.51 (ACEF score) to 0.58 (LSSextended).

      Conclusions

      In CR patients, risk scores involving clinical variables might help to predict mortality; however, no risk scores showed helpful discrimination for MACE.

      Résumé

      Contexte

      Les scores de risque comme le score SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) (SS), le SS clinique, le SS logistique (modèle de base et modèle étendu [LSSétendu]), le score ACEF (Age, Creatinine, and Ejection Fraction) (ACEF) et le score ACEF modifié, permettent de prédire les événements cardiaques indésirables majeurs (ECIM, y compris la mortalité toutes causes confondues, l'infarctus du myocarde [IM] et la revascularisation) chez les patients ayant subi une intervention coronarienne percutanée (ICP). Toutefois, rares sont les études qui ont confirmé l'efficacité de ces scores chez les patients ayant obtenu une revascularisation complète (RC). Nous avons voulu comparer l'efficacité des scores de risque susmentionnés chez des patients ayant obtenu une RC après une ICP.

      Méthodologie

      Tous les patients (N = 10 724) ayant subi une ICP en 2013 à l'hôpital Fuwai ont été examinés et ceux qui ont obtenu une RC après une ICP ont été inclus dans l'étude. Les scores de risque ont été calculés par des cardiologues expérimentés qui n'étaient pas informés des issues cliniques de l'intervention. La discrimination des scores de risque a été évaluée par l'aire sous la courbe (ASC) ROC (receiver operating characteristic).

      Résultats

      Cinquante et un pour cent (5375/10 724) des patients ayant subi une ICP ont obtenu une RC. Après une période de suivi moyenne de 2,4 ans, les taux de mortalité, d'IM, de revascularisation et d'ECIM étaient de 1,2 %, 1,0 %, 6,3% et 7,7 %, respectivement. Le SS ne permettait pas de prédire la mortalité (ASC, 0,51; intervalle de confiance [IC] à 95 %, de 0,44 à 0,59). Tous les scores tenant compte de variables cliniques, en particulier le score ACEF modifié (ASC, 0,73; IC à 95 %, de 0,66 à 0,79), étaient prédictifs de la mortalité. Le LSSétendu était le plus précis pour l'IM (ASC, 0,68; IC à 95 %, de 0,61 à 0,75). Le SS et le LSSétendu étaient prédictifs de la revascularisation, avec des valeurs de l'ASC marginalement significatives (SS, 0,54; LSSétendu, 0,55). Aucun score n'a permis de prédire de façon particulièrement précise la survenue des ECIM, pour lesquels la valeur de l'ASC variait de 0,51 (score ACEF ) à 0,58 (LSSétendu).

      Conclusions

      Chez les patients RC, les scores de risque tenant compte de variables cliniques pourraient contribuer à prédire la mortalité; toutefois, aucun score de risque ne présentait une discrimination suffisante pour prédire la survenue des ECIM.
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