Abstract
Backgrounds: A plug-and-play standardized algorithm to identify the ischemic risk in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) could play a valuable step to help a wide spectrum of clinic workers. This study intended to investigate the ability to use the accumulation of multiple clinical routine risk scores to predict long-term ischemic events in patients with CAD undergoing PCI.Methods: This was a secondary analysis of the I-LOVE-IT 2 (Evaluate Safety and Effectiveness of the Tivoli drug-eluting stent (DES) and the Firebird DES for Treatment of Coronary Revascularization) trial, which was a prospective, multicenter, and randomized study. The Global Registry for Acute Coronary Events (GRACE), baseline Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX), residual SYNTAX, and age, creatinine, and ejection fraction (ACEF) score were calculated in all patients. Risk stratification was based on the number of these four scores that met the established thresholds for the ischemic risk. The primary end point was ischemic events at 48 months, defined as the composite of cardiac death, nonfatal myocardial infarction, stroke, or definite/probable stent thrombosis (ST).Results: The 48-month ischemic events had a significant trend for higher event rates (from 6.61 to 16.93%) with an incremental number of risk scores presenting the higher ischemic risk from 0 to ≥3 (p trend < 0.001). In addition, the categories were associated with increased risk for all components of ischemic events, including cardiac death (from 1.36 to 3.15%), myocardial infarction (MI) (from 3.31 to 9.84%), stroke (3.31 to 6.10%), definite/probable ST (from 0.58 to 1.97%), and all-cause mortality (from 2.14 to 6.30%) (all p trend < 0.05). The net reclassification index after combined with four risk scores was 12.5% (5.3–20.0%), 9.4% (2.0–16.8%), 12.1% (4.5–19.7%), and 10.7% (3.3–18.1%), which offered statistically significant improvement in the performance, compared with SYNTAX, residual SYNTAX, ACEF, and GRACE score, respectively.Conclusion: The novel multiple risk score model was significantly associated with the risk of long-term ischemic events in these patients with an increment of scores. A meaningful improvement to predict adverse outcomes when multiple risk scores were applied to risk stratification.
Highlights
Personalized medicine is a medical model that separates patients into different groups with tailored medical decisions, practices, and interventions based on their predicted risk of disease
The Global Registry for Acute Coronary Events (GRACE) score could not be calculated in 188 cases with a lack of cardiac enzymes
By using the previously validated cutoffs described in the methods, 831 patients (37.65%) based on baseline SYNTAX score, 1,053 patients (47.71%) based on residual SYNTAX score, 995 patients (45.08%) based on ACEF score, and 650 patients (29.45%) based on GRACE score met the thresholds for the intermediate or high-risk category
Summary
Personalized medicine is a medical model that separates patients into different groups with tailored medical decisions, practices, and interventions based on their predicted risk of disease. Taking a series of risk factors into account to evaluate the individual risk of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) before the decision-making process was superior to “onesize-fits-all” approaches [1,2,3]. A variety of risk scoring systems, as comprehensive predicted tools for risk assessment, have been developed to support physicians in clinical practice for these patients [4,5,6,7]. Previous studies demonstrate that an additive value of one risk score combined with a biomarker, angiographic characteristic, and with another risk score to risk predicting [12,13,14].
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