title: Prognostic utility of BCIS myocardial jeopardy score for classification of coronary disease burden and completeness of revascularization.
abstract: Several coronary disease scoring systems have been developed to predict procedural risk during revascularization. Many vary in complexity, do not specifically account for myocardium at risk, and are not applicable across all patient subsets. The British Cardiovascular Intervention Society myocardial jeopardy score (BCIS-JS) addresses these limitations and is applicable to all patients, including those with coronary artery bypass grafts or left main stem disease. We assessed the prognostic relevance of the BCIS-JS in patients undergoing percutaneous coronary intervention (PCI). A total of 663 patients who underwent PCI with previous left ventricular function assessment were retrospectively assessed for inclusion, incorporating 221 with previous coronary artery bypass grafting. Blinded observers calculated the BCIS-JS, before (BCIS-JS(PRE)) and after (BCIS-JS(POST)) PCI, using the revascularization index (RI) (RI = [BCIS-JS(PRE) - BCIS-JS(POST)]/BCIS-JS(PRE)), quantifying the extent of revascularization, 1 indicating full revascularization and 0 indicating no revascularization. The primary end point all-cause mortality, tracked via the Office of National Statistics. A total of 660 patients were included (66 ± 10.7 years), with 43 deaths (6.5%) occurring during 2.6 ± 1.1 years after PCI. All-cause mortality was directly related to BCIS-JS(PRE) (hazard ratio [HR] 2.96, 95% confidence interval [CI] 1.71 to 5.15, p = 0.001) and BCIS-JS(POST) (HR 4.02, 95% CI 2.41 to 6.68, p = 0.001). A RI of <0.67 was associated with increased mortality compared to a RI of ≥0.67 (HR 4.13, 95% CI 1.91 to 8.91, p = 0.0001). On multivariate analysis, a RI <0.67 (HR 1.99, 95% CI 1.03 to 3.87, p = 0.04), left ventricular dysfunction (HR 2.03, 95% CI 1.25 to 3.30, p = 0.004) and renal impairment (HR 3.75, 95% CI 1.48 to 8.64, p = 0.005) were independent predictors of mortality. In conclusion, the BCIS-JS predicts mortality after PCI and can assess the degree of revascularization, with more complete revascularization conferring a survival advantage in the medium term.
authors.affiliation: Cardiovascular Division, British Heart Foundation Centre of Excellence, St Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors.forename: Kalpa
authors.initials: K
authors.lastname: De Silva
authors.forename: Geraint
authors.initials: G
authors.lastname: Morton
authors.forename: Pierre
authors.initials: P
authors.lastname: Sicard
authors.forename: Eric
authors.initials: E
authors.lastname: Chong
authors.forename: Andreas
authors.initials: A
authors.lastname: Indermuehle
authors.forename: Brian
authors.initials: B
authors.lastname: Clapp
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D009206:Myocardium; D011379:Prognosis; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index