Bergelson et al developed a risk score for predicting hemodynamic compromise during percutaneous transluminal coronary angioplasty (PTCA). This can help identify patient at risk for a significant drop in blood pressure during the procedure. The authors are from the Boston University Medical Center.
Hemodynamic compromise considered a decrease in the systolic blood pressure >= 20 mm Hg to < 90 mm Hg during balloon inflation.
Angiographic findings found associated with hemodynamic compromise on multivariate analysis:
(1) myocardium at risk (based on comparison of the coronary angiogram and the left ventriculogram to estimate the fraction of the remaining viable myocardium distal to the stenosis undergoing dilatation).
(2) multivessel disease (> 50% stenosis in 2 of 3 main coronary territories – left anterior descending, circumflex, or right coronary arteries)
(3) pre-PTCA stenosis in percent
(4) diffuse disease (> 50% atherosclerotic narrowing > 2 cm in length in the coronary segment undergoing dilatation)
|
Parameter |
Units |
Odds Ratio (95%) |
p value |
|
multivessel disease |
present/absent |
4.3 (1.1 – 16.1) |
0.03 |
|
diffuse disease |
present/absent |
4.1 (1.0 – 16.9) |
0.05 |
|
myocardium at risk |
10% |
1.7 (1.1 – 2.7) |
0.03 |
|
pre-PTCA stenosis |
10% |
0.6 (0.3 – 1.0) |
0.05 |
multivariate analysis data from Table II, page 1542
|
Parameter |
Finding |
Points |
|
myocardium at risk |
6 – 14% |
-2 |
|
|
15 – 23% |
-1 |
|
|
24 – 32% |
0 |
|
|
33 – 41% |
1 |
|
|
42 – 50% |
2 |
|
|
51 – 59% |
3 |
|
|
60 – 68% |
4 |
|
multivessel disease |
absent |
0 |
|
|
present |
3 |
|
pre-PTCA stenosis |
50- 57% |
3 |
|
|
58 – 65% |
2 |
|
|
66 – 73% |
1 |
|
|
74 – 81% |
0 |
|
|
82 – 89% |
-1 |
|
|
90 – 97% |
-2 |
|
|
98 – 100% |
-3 |
|
diffuse disease |
absent |
0 |
|
|
present |
3 |
from Table III, page 1542
where:
• Points assignment for myocardium at risk < 6% or > 68% is not given. The former would be unlikely for a major arterial branch. The latter might occur with an anomaly of the coronary circulation.
• I am not sure what points get assigned for a pre-PTCA stenosis of < 50%. The thought here may be that the artery would not have the angioplasty performed.
score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: -5
• maximum score: 13
• The higher the score, the greater the risk of hemodynamic compromise during the procedure. A score >= 4 was used to identify patients with a significant risk for compromise.
|
Score |
Risk of Compromise |
|
<= 0 |
0% |
|
1 |
3 – 6% |
|
2 |
5 – 9% |
|
3 |
8 – 12% |
|
4 |
11 – 19% |
|
5 |
18 – 26% |
|
6 |
25 – 38% |
|
7 |
35 – 50% |
|
8 |
48 – 61% |
|
9 |
58 – 70% |
|
10 |
68 – 79% |
|
11 |
78 – 85% |
|
12 |
85 – 92% |
|
13 |
91 – 95% |
estimated from Figure 3, page 1543
Performance:
• Using a score >= 4 to indicate a high risk for hemodynamic compromise, the score had (a) a sensitivity of 81% and specificity of 74% in an initial set of 157 patients and (b) a sensitivity of 92% and specificity of 92% in a validation set of 61 patients.
Specialty: Cardiology
ICD-10: ,
