American heart journal · 2026
Comparative validation of risk scores for in-hospital complications following chronic total occlusion percutaneous coronary intervention.
СтатьяСравнительное исследованиеВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Poletti Enrico, Thotakura Sudhir, Kearney Kathleen E, Lombardi William L, Hamilton David E, Gurm Hitinder S, Brilakis Emmanouil S, Azzalini Lorenzo
Аннотация
BACKGROUND: Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is a high-risk procedure where reliable risk prediction is essential. We compared the performance of 2 risk models (Blue Cross Blue Shield of Michigan Cardiovascular Consortium [BMC2] and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS-CTO]) for the prediction of in-hospital outcomes after CTO-PCI.
METHODS: We retrospectively analysed 1,157 CTO-PCI procedures performed at a single tertiary center between 2019 and 2023. Primary endpoint was in-hospital mortality. Discrimination was assessed with the area under the curve (AUC) method and calibration with calibration plots. Model accuracy was further quantified by the Brier score.
RESULTS: Major adverse cardiac and cerebrovascular events (MACCE) occurred in 3.0% (n = 35), and mortality in 1.0% (n = 11). The BMC2 score outperformed PROGRESS-CTO for mortality prediction (AUC 0.96 vs 0.71; P < .001). BMC2 achieved excellent prediction for acute kidney injury (AUC 0.93), dialysis (0.91), and stroke (0.84), while PROGRESS-CTO provided moderate accuracy for periprocedural myocardial infarction, pericardiocentesis (both AUC 0.71), coronary perforation (AUC 0.72) and MACCE (AUC 0.62). Calibration plots indicated better calibration for the PROGRESS-CTO model, while both models showed low overall prediction error (Brier score).
CONCLUSIONS: In CTO-PCI, BMC2 offers superior performance for in-hospital mortality prediction. Their complementary features suggest BMC2 as a powerful, data-demanding, and patient-focused tool, while PROGRESS-CTO as an easy-to-calculate, procedure-oriented model.
METHODS: We retrospectively analysed 1,157 CTO-PCI procedures performed at a single tertiary center between 2019 and 2023. Primary endpoint was in-hospital mortality. Discrimination was assessed with the area under the curve (AUC) method and calibration with calibration plots. Model accuracy was further quantified by the Brier score.
RESULTS: Major adverse cardiac and cerebrovascular events (MACCE) occurred in 3.0% (n = 35), and mortality in 1.0% (n = 11). The BMC2 score outperformed PROGRESS-CTO for mortality prediction (AUC 0.96 vs 0.71; P < .001). BMC2 achieved excellent prediction for acute kidney injury (AUC 0.93), dialysis (0.91), and stroke (0.84), while PROGRESS-CTO provided moderate accuracy for periprocedural myocardial infarction, pericardiocentesis (both AUC 0.71), coronary perforation (AUC 0.72) and MACCE (AUC 0.62). Calibration plots indicated better calibration for the PROGRESS-CTO model, while both models showed low overall prediction error (Brier score).
CONCLUSIONS: In CTO-PCI, BMC2 offers superior performance for in-hospital mortality prediction. Their complementary features suggest BMC2 as a powerful, data-demanding, and patient-focused tool, while PROGRESS-CTO as an easy-to-calculate, procedure-oriented model.