Relation between lesion characteristics and risk with percutaneous intervention in the stent and glycoprotein IIb/IIIa era - An analysis of results from 10 907 lesions and proposal for new classification scheme
Relation between lesion characteristics and risk with percutaneous intervention in the stent and glycoprotein IIb/IIIa era - An analysis of results from 10 907 lesions and proposal for new classification scheme
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DOI：
10.1161/01.cir.100.19.1971
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发表时间：
1999-11-09
期刊：
影响因子：
37.8
通讯作者：
Topol, EJ
中科院分区：
文献类型：
--
作者：
Ellis, SG;Guetta, V;Topol, EJ
背景-目前使用的美国心脏病学会/美国心脏协会病变分类方案可以追溯到球囊血管成形术是唯一可用的经皮治疗的时代，大约7%的患者发生严重并发症。治疗方案的重大进展表明，该计划可能是过时的，但已建议更新病变classification.Methods和结果的计划，四千一百八十一个连续的患者（6676病变）形成了一个训练集和2146例（4231病变）形成了一个验证集治疗：1995年至1997年在一个单一的中心使用的3个医院组。采用逐步比例逻辑回归分析27个治疗前候选变量，（非慢性完全闭塞，TIMI血流为0，静脉移植物退化，静脉移植物年龄>10年，病变长度大于或等于10 mm，严重钙化，病变不规则，大充盈缺损，成角大于或等于45度加钙，和偏心率）与分级的不良结局（死亡、Q波或肌酸激酶大于或等于3倍正常心肌梗死或急诊冠状动脉旁路移植术>>肌酸激酶2至3倍心肌梗死>>可能与非Q波心肌梗死相关>>无并发症）独立相关（P < 0.05）。基于这些发现的方案和旧的美国心脏病学会/美国心脏协会方案在0.672和0.620的验证集中具有c统计量（P = 0.010 vs旧方案），respectively.Conclusions-对这些当代冠状动脉介入治疗并发症的危险因素的认识可能有助于患者的选择和风险调整，以比较提供商
Background-The currently used American College of Cardiology/American Heart Association lesion classification scheme dates from an era when balloon angioplasty was the only percutaneous treatment available and major complications occurred in approximate to 7% of patients. Major advances in treatment options would suggest that this scheme may be outmoded, but the schemes that have been suggested to update lesion classification have not been widely accepted.Methods and Results-Four thousand one hundred eighty-one consecutive patients (6676 lesions) formed a training set and 2146 patients (4231 lesions) formed a validation set treated from :1995 to 1997 at a single center used by 3 hospital groups. Twenty-seven pretreatment candidate variables were analyzed with the use of stepwise proportional logistic regression, and 9 (nonchronic total occlusion with TIMI flow 0, degenerated vein graft, vein graft age >10 years, lesion length greater than or equal to 10 mm, severe calcium, lesion irregularity, large filling defect, angulated greater than or equal to 45 degrees plus calcium, and eccentricity) were independently correlated (P < 0.05) with ranked adverse outcome (death, Q-wave or creatine kinase greater than or equal to 3x normal myocardial infarction, or emergency coronary artery bypass grafting>>creatine kinase 2 to 3x myocardial infarction>>possibly related to non-Q-wave myocardial infarction>>no complication). A scheme based on these findings and the old American College of Cardiology/American Heart Association scheme were found to have c-statistics in the validation set of 0.672 and 0.620 (P = 0.010 vs old scheme), respectively.Conclusions-Appreciation of these contemporary risk factors for complications of coronary intervention may assist in patient selection and in risk adjustment for comparison of outcomes between providers.