Clinical Use of CathPCI Registry Risk Score and Its Validation to Predict Long-Term Mortality.

Risk models to estimate percutaneous coronary intervention (PCI) mortality have limited value in complex high-risk patients. However, it was improved by a recently developed bedside model to predict in-hospital mortality using data from the American College of Cardiology CathPCI Registry that included 706,263 patients. The median risk-standardized in-hospital mortality rate was 1.9%. In an attempt to validate this model in patients admitted because of acute coronary ischemia to predict in-hospital, 30-day, and 1-year mortality, we applied the proposed risk score to the study population of the Acute Coronary Syndrome Israeli Survey (ACSIS). This study was conducted for 2 months in 2018 and included all patients admitted to 25 coronary care units and cardiology departments in Israel. The ACSIS included 1,155 patients admitted because of acute myocardial infarction and who underwent PCI. In-hospital, 30-day, and 1-year mortality were 2.3%, 3.1%, and 6.2%, respectively. The CathPCI risk score yielded an area under the receiver operating characteristic curve of 0.96 (95% confidence interval [CI] 0.94 to 0.99) for in-hospital mortality; 0.96 (95% CI 0.94 to 0.98) for the 30-day mortality, and 0.88 (95% CI 0.83 to 0.93) for the 1-year mortality. The current model also included frail patients, and those with aortic stenosis, refractory shock, and after cardiac arrest. In conclusion, the CathPCI Registry risk score was validated using data from the ACSIS. Because the ACSIS population comprised patients with acute ischemia including those with high-risk features this model demonstrates a wider scope of application compared with previous ones. In addition, the model seems to be suitable to predict also the 30-day and 1-year mortality.

Usefulness of the CHA2DS2-VASC Score to Predict Adverse Outcomes in Patients Having Percutaneous Coronary Intervention.

The application of the CHA2DS2-VASC score as a novel risk stratification tool for predicting outcome in clinical applications other than atrial fibrillation and stroke prevention has been previously examined. However, its usefulness in a population of patients with coronary artery disease after percutaneous coronary intervention (PCI) has not been explored. We investigated 12,785 consecutive patients who underwent PCI in a tertiary medical center from April 2004 to August 2014 (mean follow-up 6.5 years) and computed the CHA2DS2-VASC score on their index PCI. We assessed the relation between the CHA2DS2-VASC score and clinical outcomes (for example, all-cause mortality and mortality or myocardial infarction) at 1 and 5 years. The mean CHA2DS2-VASC score was 3.7 ± 1.7, 59.1% of patients obtained a score of 3 to 5. Both the primary and secondary outcomes at 1 and 5 years were significantly more frequent as the CHA2DS2-VASC score increased. Overall, the mortality rate after PCI was 10 times higher for patients with a CHA2DS2-VASC score of 5 compared with a score of 1 at both 1-and 5-year follow-up. The CHA2DS2-VASC score predicted all-cause mortality and death or nonfatal myocardial infarction in a significant (p <0.001, C-index 0.73 and 0.72) and linear fashion. In conclusion, the CHA2DS2-VASC score can be used as a simple and effective tool to predict long-term clinical outcomes in patients undergoing PCI.