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. 2022 Jan 10;15(1):39-49.
doi: 10.1016/j.jcin.2021.09.039.

Defining Percutaneous Coronary Intervention Complexity and Risk: An Analysis of the United Kingdom BCIS Database 2006-2016

Majd Protty  1 , Andrew S P Sharp  1 , Sean Gallagher  1 , Vasim Farooq  1 , James C Spratt  2 , Peter Ludman  3 , Richard Anderson  1 , Margaret M McEntegart  4 , Colm Hanratty  5 , Simon Walsh  6 , Nick Curzen  7 , Elliot Smith  8 , Mamas Mamas  9 , Tim Kinnaird  10
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Free article

Defining Percutaneous Coronary Intervention Complexity and Risk: An Analysis of the United Kingdom BCIS Database 2006-2016

Majd Protty et al. JACC Cardiovasc Interv. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Cardiovasc Interv. 2022 Aug 22;15(16):1694-1695. doi: 10.1016/j.jcin.2022.07.022. JACC Cardiovasc Interv. 2022. PMID: 35981852 No abstract available.

Abstract

Objectives: The authors used the BCIS (British Cardiovascular Intervention Society) database to define the factors associated with percutaneous coronary intervention (PCI) procedural complexity.

Background: Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly defined.

Methods: The BCIS (British Cardiovascular Intervention Society) database was used to study all PCI procedures in the United Kingdom 2006-2016. A multiple logistic regression model was developed to identify variables associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE) and to construct a CHIP score. The cumulative effect of this score on patient outcomes was examined.

Results: A total of 313,054 patients were included. Seven patient factors (age ≥80 years, female sex, previous stroke, previous myocardial infarction, peripheral vascular disease, ejection fraction <30%, and chronic renal disease) and 6 procedural factors (rotational atherectomy, left main PCI, 3-vessel PCI, dual arterial access, left ventricular mechanical support, and total lesion length >60 mm) were associated with increased in-hospital MACCE and defined as CHIP factors. The mean CHIP score/case for all PCIs increased significantly from 1.06 ± 1.32 in 2006 to 1.49 ± 1.58 in 2016 (P < 0.001 for trend). A CHIP score of 5 or more was present in 2.5% of procedures in 2006 increasing to 5.3% in 2016 (P < 0.001 for trend). Overall in-hospital MACCE was 0.6% when the CHIP score was 0 compared with 1.2% with any CHIP factor present (P < 0.001). As the CHIP score increased, an exponential increase in-hospital MACCE was observed. The cumulative MACCE for procedures associated with a CHIP score 4+ or above was 3.2%, and for a CHIP score 5+ was 4.4%. All other adverse clinical outcomes were more likely as the CHIP score increased.

Conclusions: Seven patient factors and 6 procedural factors were associated with adverse in-hospital MACCE and defined as CHIP factors. Use of a CHIP score might be a future target for risk modification.

Keywords: CHIP-PCI; complex PCI; national database; patient outcomes.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

  • CHIP Score: Do We Really Need One?
    Helmy T, Mina G. Helmy T, et al. JACC Cardiovasc Interv. 2022 Jan 10;15(1):50-51. doi: 10.1016/j.jcin.2021.11.021. JACC Cardiovasc Interv. 2022. PMID: 34991823 No abstract available.