BACKGROUND
Accurate risk stratification for patients with three-vessel coronary artery disease (3VD) undergoing percutaneous coronary intervention (PCI) remains important in contemporary practice. SYNTAX-based mortality prediction models require reassessment in modern PCI populations.
METHODS
This post-hoc analysis of the Multivessel TALENT trial evaluated the core and extended logistic clinical SYNTAX Score (LCSS) for predicting 1-year all-cause mortality. Discrimination was assessed using the area under the receiver-operating characteristic curve (AUC), and calibration using calibration intercept, calibration slope, graphical calibration, and the E-statistic. Prediction scores were calculated within each of 20 imputed datasets, with model performance evaluated within each imputation and summarised across imputations. Intercept-and-slope recalibration and decision curve analysis were also performed.
RESULTS
At 1 year, 46 (3.0%) of 1,548 enrolled patients had died. The pooled AUCs were 0.716 for the LCSS core model and 0.744 for the extended model, compared with 0.629 for the anatomical SYNTAX Score and 0.632 for the functional SYNTAX Score. LCSS models systematically overestimated absolute risk, although observed mortality increased across predicted-risk quintiles. Decision curve analysis showed a positive net benefit for the original and recalibrated LCSS models across threshold probabilities of 1% to 10%, with numerically higher net benefit for the recalibrated extended model across much of the evaluated threshold range.
CONCLUSION
In contemporary PCI for 3VD, the LCSS showed moderate discrimination for 1-year all-cause mortality while overestimating its absolute risk. Recalibration improved agreement with observed risk in this cohort and may inform future validation and model refinement.
A. Oshima, N. Kanehama, D. van Klaveren et al.· European Heart Journal - Qua...· 0 citations
Background Evidence regarding the link between imaging modality and stroke prevention outcomes of left atrial appendage occlusion is currently lacking. Methods The RECORD (Registry to Evaluate Chinese Real‐World Clinical Outcomes in Patients With AF Using the WATCHMAN Left Atrial Appendage Closure Technology) trial prospectively enrolled 3096 consecutive patients undergoing left atrial appendage occlusion from 39 Chinese centers between April 1, 2019, and October 31, 2020. In the current analyses, patients were stratified into the echocardiographic guidance (transesophageal echocardiography/intracardiac echocardiography) group and the fluoroscopy‐only group. The primary end point was the composite end point of death, stroke, or systemic embolism at 3 years. Outcomes were estimated using the Kaplan–Meier method. Inverse probability of treatment weighting and 1:1 propensity score matching were performed to calculate hazard ratios (HRs) for each outcome at the time of interest. Results Among 3096 participants, 2603 (84.1%) underwent transesophageal echocardiography/intracardiac echocardiography–guided procedures and 493 (15.9%) underwent fluoroscopy‐only guided procedures. Before discharge, procedural complications occurred in 34 patients (1.4%) in the transesophageal echocardiography/intracardiac echocardiography group and 3 patients (0.6%) in the fluoroscopy‐only group (inverse probability of treatment weighting–adjusted absolute difference, −0.67 [95% CI, −1.39 to 0.05], P=0.066). At 3‐year follow‐up (completed by 2989 patients, 97.0%), the primary end point occurred in 269 (10.5%) patients in the transesophageal echocardiography/intracardiac echocardiography group and 52 (10.6%) patients in the fluoroscopy‐only group (inverse probability of treatment weighting–adjusted HR, 1.13 [95% CI, 0.81–1.57], P=0.469). Ischemic stroke was comparable between groups (3.0% versus 4.1%, inverse probability of treatment weighting–adjusted HR, 1.66 [95% CI, 0.95–2.89], P=0.073). These findings remained consistent across patient risk profiles and operator experience levels. Conclusions Fluoroscopy‐only guidance, without compromising long‐term stroke prevention efficacy, may serve as a streamlined and potentially accessible alternative for left atrial appendage occlusion procedures performed with the first‐generation WATCHMAN 2.5 device, and these findings apply to select patients and experienced centers. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03917563.
Ping Wang, Zhengquan Chen, Yongmeng Yan et al.· Journal of the American Hear...· 0 citations
