Author + information
- Received February 11, 2020
- Revision received April 17, 2020
- Accepted April 21, 2020
- Published online July 20, 2020.
- Doyeon Hwang, MDa,
- Joo Myung Lee, MD, MPH, PhDb,
- Seokhun Yang, MDa,
- Mineok Chang, MD, PhDa,
- Jinlong Zhang, MDa,
- Ki Hong Choi, MDb,
- Chee Hae Kim, MDc,
- Chang-Wook Nam, MD, PhDd,
- Eun-Seok Shin, MD, PhDe,
- Jae-Jin Kwak, MD, PhDf,
- Joon-Hyung Doh, MD, PhDf,
- Masahiro Hoshino, MDg,
- Rikuta Hamaya, MDg,
- Yoshihisa Kanaji, MD, PhDg,
- Tadashi Murai, MD, PhDg,
- Jun-Jie Zhang, PhDh,
- Fei Ye, MDh,
- Xiaobo Li, MDh,
- Zhen Ge, MDh,
- Shao-Liang Chen, MD, PhDh,∗∗ (, )
- Tsunekazu Kakuta, MD, PhDg and
- Bon-Kwon Koo, MD, PhDa,∗ ()
- aDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- bDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- cDivision of Cardiology, Department of Internal Medicine, VHS Medical Center, Seoul, Korea
- dDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- eDivision of Cardiology, Ulsan Hospital, Ulsan, Korea
- fDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
- gDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
- hDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- ↵∗Address for correspondence:
Dr. Bon-Kwon Koo, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea.
- ↵∗∗Dr. Shao-Liang Chen, Nanjing Medical University, 68 Changle Road, Qinghuai District, Nanjing, Jiangsu Province 210006, China.
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)
Dr. Lee has received research grants from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Doh has received a research grant from Philips Volcano. Dr. Koo has received institutional research grants from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Chen is a consultant for Microport and Boston Scientific International; and has received a grant from the National Natural Scientific Foundation of China. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received February 11, 2020.
- Revision received April 17, 2020.
- Accepted April 21, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.