Novel risk score for patients undergoing Impella-assisted high-risk percutaneous coronary intervention.
| Title: | Novel risk score for patients undergoing Impella-assisted high-risk percutaneous coronary intervention. |
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| Authors: | Lemor A; Department of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.; Shah T; Division of Cardiovascular Medicine, Penn Medicine: University of Pennsylvania Health System, Philadelphia, PA, USA; Division of Cardiology, Yale School of Medicine, New Haven, CT, USA.; Thompson JB; Clinical Trials Center, Cardiovascular Research Foundation, NY, New York, USA.; Protty MB; Systems Immunity University Research Institute, Cardiff University, Cardiff, UK.; Mamas MA; National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.; Kinnaird T; Department of Cardiology, University Hospital of Wales, Cardiff, UK.; Bharadwaj AS; Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA.; Truesdell AG; Virginia Heart / Inova Schar Heart and Vascular, Falls Church, VA, USA.; Schonning MJ; Clinical Trials Center, Cardiovascular Research Foundation, NY, New York, USA.; Zhang Y; Clinical Trials Center, Cardiovascular Research Foundation, NY, New York, USA.; Hussain Y; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven, CA, USA.; Falah B; Clinical Trials Center, Cardiovascular Research Foundation, NY, New York, USA.; Cohen DJ; Clinical Trials Center, Cardiovascular Research Foundation, NY, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA.; Redfors B; Clinical Trials Center, Cardiovascular Research Foundation, NY, New York, USA; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA; Department of Molecular and Clinical Medicine, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Baron SJ; Massachusetts General Hospital, Boston, MA, USA; Baim Institute for Clinical Research, Boston, MA, USA.; Witzke CF; Department of Medicine, Jefferson Einstein Hospital, Philadelphia, PA, USA; Department of Cardiology, Jefferson Einstein Hospital, Philadelphia, PA, USA.; Dixon SR; Department of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, MI, USA.; Basir MB; Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA.; Lansky AJ; Division of Cardiology, Yale School of Medicine, New Haven, CT, USA; Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom.; O'Neill WW; Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA. Electronic address: woneill1@hfhs.org. |
| Source: | Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2025 Dec; Vol. 81, pp. 86-94. Date of Electronic Publication: 2025 May 30. |
| Publication Type: | Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 101238551 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-0938 (Electronic) Linking ISSN: 18780938 NLM ISO Abbreviation: Cardiovasc Revasc Med Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York, NY : Elsevier, c2005- |
| MeSH Terms: | Percutaneous Coronary Intervention*/adverse effects ; Percutaneous Coronary Intervention*/mortality ; Coronary Artery Disease*/mortality ; Coronary Artery Disease*/therapy ; Coronary Artery Disease*/physiopathology ; Coronary Artery Disease*/diagnostic imaging ; Heart Failure*/mortality ; Heart Failure*/therapy ; Heart Failure*/physiopathology ; Heart Failure*/diagnosis ; Prosthesis Implantation*/instrumentation ; Prosthesis Implantation*/adverse effects ; Prosthesis Implantation*/mortality ; Heart-Assist Devices* ; Ventricular Function, Left* ; Decision Support Techniques*; Humans ; Risk Assessment ; Male ; Female ; Aged ; Middle Aged ; Hospital Mortality ; United States ; Treatment Outcome ; Predictive Value of Tests ; Registries ; Risk Factors ; Time Factors ; 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 (R2 = 0.30). The CHIP-PCI score had poor discrimination (C-index 0.61) and reasonable goodness of fit (R2 = 0.62). Five independent predictors of in-hospital mortality were identified: age >80 years, eGFR |
| Competing Interests: | Declaration of competing interest Dr. Lemor reports speaker fees from Abiomed. Dr. Shah has received speaking honorariums from Abiomed. Dr. Mamas reports holding unrestricted educational grants from Boston Scientific, Terumo, and Abbott. Dr. Bharadwaj reports consulting and speaker fees from Abiomed, Shockwave Medical, and Cardiovascular Systems, Inc. Dr. Truesdell reports speaking/consultant fees from Abiomed, Getinge, Shockwave, Zoll. Dr. Cohen has received research grant support from Edwards Lifesciences, Abbott, Boston Scientific, Corvia Medical, Philips, Brain-Q, Saranas, Zoll Medical, CathWorks, and ANCORA, and has received consultant fees from Medtronic, Edwards Lifesciences, Abbott, AngioInsight, and HeartBeam. Dr. Redfors has received consultant fees from Pfizer and Boehringer Ingelheim. Dr. Baron reports receiving institutional research support from Boston Scientific Corporation, Acarix and Abiomed; speaker fees from Medtronic, Edwards LifeSciences, Shockwave and Zoll Medical; and consulting fees/advisory board membership from Medtronic, Boston Scientific Corporation, Zoll Medical and Abiomed. All other coauthors have no other relevant disclosures. Dr. Basir reports consultant fees from Abiomed, Boston Scientific, Chiesi, Saranas and Zoll. Dr. Lansky has received speaker fees from Keystone Heart. Dr. O'Neill reports grant/research support from St. Jude Medical, Edwards Life Sciences, and Biomed; consulting fees/honoraria from Medtronic and Abiomed; and major stock shareholder/equity in Synecor, Accumed, Neovasc, Tendyne, and Mitral Align. All other coauthors have no other relevant disclosures. |
| Contributed Indexing: | Keywords: CHIP risk score; HRPCI risk score; High-risk percutaneous coronary intervention; In hospital mortality; NCDR risk score |
| Molecular Sequence: | ClinicalTrials.gov NCT04136392 |
| Entry Date(s): | Date Created: 20250620 Date Completed: 20251212 Latest Revision: 20260521 |
| Update Code: | 20260522 |
| DOI: | 10.1016/j.carrev.2025.05.031 |
| PMID: | 40541479 |
| Database: | MEDLINE |
Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't