Baran et al reported a score for predicting the clinical risk for a very late stent thrombosis in a patient with a drug-eluting stent. The authors are from the United Heart Clinic in St. Paul, Washington University, Lehigh Valley Hospital, and Boston Scientific Corporation.
Patient selection: drug-eluting stent
Outcome: very late stent thrombosis (VLST, occurring > 1 year after placement)
Parameters:
(1) renal disease (serum creatinine > 3 mg/dL or patient on dialysis)
(2) multiple stentings (includes same vessel, overlapping, multi-vessel)
(3) prior myocardial infarction (previous to episode with stenting)
(4) smoking at baseline (placement of stent)
(5) previous coronary artery bypass graft (CABG)
(6) bifurcation lesion
|
Parameter |
Finding |
Points |
|
renal disease |
no |
0 |
|
|
yes |
3 |
|
multiple stentings |
no |
0 |
|
|
yes |
2 |
|
prior myocardial infarction |
no |
0 |
|
|
yes |
2 |
|
smoking |
no |
0 |
|
|
yes |
1 |
|
previous CABG |
no |
0 |
|
|
yes |
1 |
|
bifurcation lesion |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 6 paraemters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk of very late stent thrombosis.
• A score >= 5 was high risk and a score <= 4 was low risk. Looking at the data an alternative might be to make 5 to 7 intermediate risk and >= 8 high risk.
|
Total Score |
Percent with VLST |
|
0-2 |
<= 0.5% |
|
3 |
1% |
|
4 |
0.7% |
|
5 |
2.3% |
|
6 |
3.25% |
|
7 |
3.5% |
|
8 |
7.4% |
Performance:
• The C-statistic (area under the ROC curve) is 0.7.
Specialty: Cardiology
ICD-10: ,
