Doyeon Hwang1, Joo Myung Lee2, Seokhun Yang1, Mineok Chang1, Jinlong Zhang1, Ki Hong Choi2, Chee Hae Kim3, Chang-Wook Nam4, Eun-Seok Shin5, Jae-Jin Kwak6, Joon-Hyung Doh6, Masahiro Hoshino7, Rikuta Hamaya7, Yoshihisa Kanaji7, Tadashi Murai7, Jun-Jie Zhang8, Fei Ye8, Xiaobo Li8, Zhen Ge8, Shao-Liang Chen9, Tsunekazu Kakuta7, Bon-Kwon Koo10. 1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea. 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3. Division of Cardiology, Department of Internal Medicine, VHS Medical Center, Seoul, Korea. 4. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. 5. Division of Cardiology, Ulsan Hospital, Ulsan, Korea. 6. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 7. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan. 8. Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 9. Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address: chmengx@126.com. 10. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea. Electronic address: bkkoo@snu.ac.kr.
Abstract
OBJECTIVES: The aim of this study was to develop a risk model incorporating clinical, angiographic, and physiological parameters to predict future clinical events after drug-eluting stent implantation. BACKGROUND: Prognostic factors after coronary stenting have not been comprehensively investigated. METHODS: A risk model to predict target vessel failure (TVF) at 2 years was developed from 2,200 patients who underwent second-generation drug-eluting stent implantation and post-stent fractional flow reserve (FFR) measurement. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. A random survival forest model with automatic feature selection by minimal depth analysis was used for risk model development. RESULTS: During 2 years of follow-up, the cumulative incidence of TVF was 5.9%. From clinical, angiographic, and physiological parameters, 6 variables were selected for the risk model in order of importance within the model as follows: total stent length, post-stent FFR, age, post-stent percentage diameter stenosis, reference vessel diameter, and diabetes mellitus. Harrell's C index of the random survival forest model was 0.72 (95% confidence interval [CI]: 0.62 to 0.82). This risk model showed better prediction ability than models with clinical risk factors alone (Harrell's C index = 0.55; 95% CI: 0.41 to 0.59; p for comparison = 0.005) and with clinical risk factors and angiographic parameters (Harrell's C index = 0.65; 95% CI: 0.52 to 0.77; p for comparison = 0.045). When the patients were divided into 2 groups according to the median of total stent length (30 mm), post-stent FFR and total stent length showed the highest variable importance in the short- and long-stent groups, respectively. CONCLUSIONS: A risk model incorporating clinical, angiographic, and physiological predictors can help predict the risk for TVF at 2 years after coronary stenting. Total stent length and post-stent FFR were the most important predictors. (International Post PCI FFR Registry; NCT04012281).
OBJECTIVES: The aim of this study was to develop a risk model incorporating clinical, angiographic, and physiological parameters to predict future clinical events after drug-eluting stent implantation. BACKGROUND: Prognostic factors after coronary stenting have not been comprehensively investigated. METHODS: A risk model to predict target vessel failure (TVF) at 2 years was developed from 2,200 patients who underwent second-generation drug-eluting stent implantation and post-stent fractional flow reserve (FFR) measurement. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. A random survival forest model with automatic feature selection by minimal depth analysis was used for risk model development. RESULTS: During 2 years of follow-up, the cumulative incidence of TVF was 5.9%. From clinical, angiographic, and physiological parameters, 6 variables were selected for the risk model in order of importance within the model as follows: total stent length, post-stent FFR, age, post-stent percentage diameter stenosis, reference vessel diameter, and diabetes mellitus. Harrell's C index of the random survival forest model was 0.72 (95% confidence interval [CI]: 0.62 to 0.82). This risk model showed better prediction ability than models with clinical risk factors alone (Harrell's C index = 0.55; 95% CI: 0.41 to 0.59; p for comparison = 0.005) and with clinical risk factors and angiographic parameters (Harrell's C index = 0.65; 95% CI: 0.52 to 0.77; p for comparison = 0.045). When the patients were divided into 2 groups according to the median of total stent length (30 mm), post-stent FFR and total stent length showed the highest variable importance in the short- and long-stent groups, respectively. CONCLUSIONS: A risk model incorporating clinical, angiographic, and physiological predictors can help predict the risk for TVF at 2 years after coronary stenting. Total stent length and post-stent FFR were the most important predictors. (International Post PCI FFR Registry; NCT04012281).
Authors: Pepijn A van Diemen; Ruben W de Winter; Stefan P Schumacher; Michiel J Bom; Roel S Driessen; Henk Everaars; Ruurt A Jukema; Yvemarie B Somsen; Lenka Popelkova; Peter M van de Ven; Albert C van Rossum; Tim P van de Hoef; Stefan de Haan; Koen M Marques; Jorrit S Lemkes; Yolande Appelman; Alexander Nap; Niels J Verouden; Maksymilian P Opolski; Ibrahim Danad; Paul Knaapen Journal: J Interv Cardiol Date: 2021-08-31 Impact factor: 2.279
Authors: Zuoyi Zhou; Baozhen Zhu; Fangfang Fan; Fan Yang; Shu Fang; Zhi Wang; Lin Qiu; Yanjun Gong; Yong Huo Journal: Front Cardiovasc Med Date: 2022-03-21
Authors: Doyeon Hwang; Bon-Kwon Koo; Jinlong Zhang; Jiesuck Park; Seokhun Yang; Minsang Kim; Jun Pil Yun; Joo Myung Lee; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Shao-Liang Chen; Tsunekazu Kakuta; Gabor G Toth; Zsolt Piroth; Nils P Johnson; Nico H J Pijls; Abdul Hakeem; Barry F Uretsky; Yohei Hokama; Nobuhiro Tanaka; Hong-Seok Lim; Tsuyoshi Ito; Akiko Matsuo; Lorenzo Azzalini; Massoud A Leesar; Tara Neleman; Nicolas M van Mieghem; Roberto Diletti; Joost Daemen; Damien Collison; Carlos Collet; Bernard De Bruyne Journal: JAMA Netw Open Date: 2022-09-01