Among patients undergoing percutaneous coronary intervention (PCI), there is a need for risk stratification for successful planning and post procedural management. Risk stratification is paramount for effective decision making.
For a long time, the SYNTAX score has been the preferred tool for complex PCI patient risk assessment. However, it has important limitations, such as inter-observer variability, anatomical details, and the fact that it has been designed for multivessel or left main disease.
Recently, the British Society of Cardiovascular Intervention (BCIS) developed a complex high-risk indicated percutaneous coronary intervention (CHIP) score based on clinical and procedural characteristics. These variables consist of: age ≥ 80 years (2 points), female sex (1 point), peripheral artery disease (2 points), prior stroke (1 point), prior MI (1 point), chronic kidney disease (2 points), ejection fraction < 30% (2 points), three-vessel PCI (2 points), left main PCI (1 point), total stent length > 60 mm (1 point), dual arterial access (1 point), use of upfront LV support (3 points) and rotational atherectomy (1 point). This score, validated in the UK, has shown that high values are associated with progressive increase of inhospital mortality and major adverse events.
The aim of this study was to assess BCIS CHIP score performance in determining the risk of major cardiac and cerebrovascular events (MACCE) as well as other ischemic and bleeding complications at 1 year followup in patients undergoing complex PCI in one US center.
Primary end point was MACCE at one year defined as a composite of death, MI and stroke. Secondary end point included individual primary end components plus target vessel revascularization (TVR) at one year, inhospital MACCE and inhospital bleeding.
It included 20779 patients from Mount Sinai Hospital in New York, intervened from January 2011 to December 2020. Mean age was 66 and they were mostly men. Patients were risk-stratified according to BCIS CHIP score. Most patients presented BCIS CHIP score 1-2 (N=8.001, 38.5%), followed by score 0 (N=4.932, 23.7%), score 3-4 (N=4.768, 22.9%) and score ≥ 5 (N=3.098, 14.9%).
Primary end point at 1 year occurred in 1.7% in score 0 patients, 3% in score 1-2 patients, 6.1% in score 3-4 patients, and 12% in score ≥5 patents. MACCE risk showed a significant progressive increase from score 0 to score ≥ 5 (score 1-2, HR: 1.72; 95% CI: 1.32-2.24, P < 0.001; score 3-4, HR: 3.60; 95% CI: 2.78-4.66; P < 0.001; score ≥5, HR: 7.40; 95% CI: 5.75- 9.51; P < 0.001). For every one-point increase in BCIS CHIP score, MACCE risk increased by 28% at one year. All-cause death rate was significantly higher in patients with BCIS CHIP score 3-4 (HR: 4.76; 95% CI: 3.22-7.03; P < 0.001) or BCIS-CHIP score ≥5 (HR: 12.00; 95% CI: 8.26-17.50; P < 0.001) compared against score 0. This significant difference between scores was also observed in MI, TVR and major bleeding rates.
Conclusion
BCIS CHIP score has been shown useful to predict MACCE at 1 year in a cohort of patients undergoing PCI in the US: This score could be useful for decision making and PCI patient risk stratifying.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Validation of UK-BCIS CHIP Score to Predict 1-Year Outcomes in a Contemporary United States Population.
Reference: Gaurav Khandelwal, MD et al J Am Coll Cardiol Intv 2023;16:1011–1020.
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