Novel risk score for patients undergoing Impella-assisted high-risk percutaneous coronary intervention
Recommended Citation
Lemor A, Shah T, Thompson JB, Protty MB, Mamas MA, Kinnaird T, Bharadwaj AS, Truesdell AG, Schonning MJ, Zhang Y, Hussain Y, Falah B, Cohen DJ, Redfors B, Baron SJ, Witzke CF, Dixon SR, Basir MB, Lansky AJ, and O'Neill WW. Novel risk score for patients undergoing Impella-assisted high-risk percutaneous coronary intervention. Cardiovasc Revasc Med 2025;81:86-94.
Document Type
Article
Publication Date
12-1-2025
Publication Title
Cardiovasc Revasc Med
Keywords
Humans, Heart-Assist Devices, Percutaneous Coronary Intervention, Risk Assessment, Male, Female, Aged, Middle Aged, Hospital Mortality, United States, Ventricular Function, Left, Treatment Outcome, Predictive Value of Tests, Registries, Decision Support Techniques, Risk Factors, Time Factors, Coronary Artery Disease, Heart Failure, Prosthesis Implantation, Clinical Decision-Making
Abstract
BACKGROUND: High-risk percutaneous coronary intervention (HRPCI) procedures supported by percutaneous left ventricular assist devices (pLVAD) are increasingly common, but existing PCI risk scores were developed in patients across the risk spectrum, including few pLVAD-assisted patients.
OBJECTIVES: Assess the performance of existing PCI risk scores in patients receiving pLVAD-assisted HRPCI and create a novel risk score specific to this group.
METHODS: Patients in the PROTECT III multicenter, observational (46 US centers) study undergoing pLVAD-assisted HRPCI were assessed. The National Cardiovascular Data Registry (NCDR) bedside risk score and the Complex High-Risk Indicated PCI (CHIP-PCI) risk score were calculated for each patient, and their accuracy in predicting in-hospital events was assessed. A novel risk score for in-hospital mortality was created using pre-procedural variables which were significant in univariable and multivariable regressions.
RESULTS: Among 1237 patients, the NCDR bedside risk score showed modest discrimination (C-index 0.71) but poor goodness of fit (R(2) = 0.30). The CHIP-PCI score had poor discrimination (C-index 0.61) and reasonable goodness of fit (R(2) = 0.62). Five independent predictors of in-hospital mortality were identified: age >80 years, eGFR < 30, left main disease, acute myocardial infarction, and left ventricular ejection fraction < 30 %. These formed the "HRPCI" risk score (C-index 0.75), which correlated with 30-day mortality (5.4 % vs. 17.0 %, p< 0.0001).
CONCLUSIONS: Existing PCI risk scores perform poorly in patients undergoing pLVAD-assisted HRPCI. A novel easily, calculable HRPCI risk score can assist in clinical decision making once validated.
CLINICAL TRIAL INFORMATION: Trial Name: The Global cVAD Study (cVAD). URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2 ClinicalTrial.gov Identifier: NCT04136392.
Medical Subject Headings
Humans; Heart-Assist Devices; Percutaneous Coronary Intervention; Risk Assessment; Male; Female; Aged; Middle Aged; Hospital Mortality; United States; Ventricular Function, Left; Treatment Outcome; Predictive Value of Tests; Registries; Decision Support Techniques; Risk Factors; Time Factors; Coronary Artery Disease; Heart Failure; Prosthesis Implantation; Clinical Decision-Making
PubMed ID
40541479
ePublication
ePub ahead of print
Volume
81
First Page
86
Last Page
94
