A risk scoring system to predict coronary stent thrombosis

<b>Objective:</b> Stent thrombosis (ST) is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We aimed to develop a scoring system to predict the risk of ST following PCI. <b>Research design and methods:</b> Odds ratios (ORs) for risk factors associated with ST were identified from a meta-analysis based on a systematic literature review, and through consensus expert opinion (Delphi–RAND method). The combined ORs were used to calculate risk scores for acute (within 24 hours), early (within 30 days) and late (31 days to 1 year) ST. Risk scores were validated against patient-level data from the TRITON-TIMI 38 study. Twenty risk factors were identified. <b>Results:</b> The most highly predictive factor for early and late ST was “incomplete duration of dual antiplatelet therapy”. Derived total risk scores ranged from 0 to 22 for acute and early ST, and from 0 to 20 for late ST. Increasing scores were associated with an increasing risk of ST when applied to trial data. Model discrimination was 0.60 (<i>p</i> = .0028), 0.67 (<i>p</i> p <b>Conclusion:</b> Our weighted scoring system may help to stratify ST risk and individualize antiplatelet therapy in patients undergoing PCI.

<b>研究目的：</b>支架血栓形成（Stent thrombosis，ST）是经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）的潜在致命并发症。本研究旨在开发一套评分系统，以预测PCI术后患者发生ST的风险。<b>研究设计与方法：</b>本研究通过基于系统文献综述的荟萃分析，结合专家共识意见（德尔菲-兰德法，Delphi–RAND method），明确了与ST相关的危险因素的比值比（Odds ratios，OR）。利用合并后的OR值，分别计算急性ST（发病24小时内）、早期ST（发病30天内）以及晚期ST（发病31天至1年）的风险评分。本研究采用TRITON-TIMI 38研究的患者个体水平数据对该风险评分进行验证，最终共确定20种危险因素。<b>研究结果：</b>早期及晚期ST预测价值最高的危险因素为“双联抗血小板治疗疗程不足”。急性与早期ST的总风险评分区间为0~22，晚期ST的总风险评分区间为0~20。将该评分应用于试验数据时，评分越高对应的ST发生风险也越高。模型区分度为0.60（<i>p</i> = 0.0028）、0.67（<i>p</i>。<b>研究结论：</b>本研究开发的加权评分系统可辅助对PCI术后患者的ST发生风险进行分层，并实现抗血小板治疗的个体化方案制定。