Relation Between Lesion Characteristics and Risk With Percutaneous Intervention in the Stent and Glycoprotein IIb/IIIa Era
Key result
New 9-factor lesion classification scheme predicts adverse post-PCI outcomes better than historical ACC/AHA criteria.
- P=0.010
- n=6,327
Why the study?
Does a contemporary lesion classification scheme better predict adverse outcomes after percutaneous coronary intervention compared to the historical ACC/AHA scheme?
Population
6,327 consecutive patients treated with percutaneous intervention from 1995 to 1997 at a single center.
Comparison
A contemporary lesion classification scheme… vs The historical American College of…
Design
Cohort
Authors
Discussion
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Implication
May improve post-PCI risk stratification; leaves open prospective validation before replacing the ACC/AHA scheme.
Study Design
Type
Cohort (n=6,327)
Multicenter
No
Structured PICO
Does a contemporary lesion classification scheme better predict adverse outcomes after percutaneous coronary intervention compared to the historical ACC/AHA scheme?
P
Population
6,327 consecutive patients (10,907 lesions) treated with percutaneous intervention from 1995 to 1997 at a single center (4,181 patients/6,676 lesions in training set; 2,146 patients/4,231 lesions in validation set).
I
Intervention
A contemporary lesion classification scheme based on 9 independently correlated variables (nonchronic total occlusion with TIMI flow 0, degenerated vein graft, vein graft age >10 years, lesion length >= 10 mm, severe calcium, lesion irregularity, large filling defect, angulated >= 45 degrees plus calcium, and eccentricity).
C
Comparator
The historical American College of Cardiology/American Heart Association lesion classification scheme.
O
Outcome
Ranked adverse outcome (death, Q-wave or creatine kinase >= 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).composite
Main Result
p-value: p=0.010
A contemporary lesion classification scheme incorporating 9 angiographic variables provides better risk prediction for percutaneous coronary intervention complications than the historical ACC/AHA scheme.
Cite This Study
Ellis et al. (1999) conducted a cohort in Coronary artery disease undergoing percutaneous intervention (n=6,327). New lesion classification scheme based on 9 contemporary risk factors vs. Old American College of Cardiology/American Heart Association lesion classification scheme was evaluated on Ranked adverse outcome (death, Q-wave or creatine kinase ≥3x normal myocardial infarction, or emergency coronary artery bypass grafting) (p=0.010). A new lesion classification scheme based on 9 risk factors predicted adverse outcomes after percutaneous intervention better than the old ACC/AHA scheme (c-statistic 0.672 vs 0.620; P=0.010).