pREdicting Long-Term Major advErse carDiac and Cerebrovascular Events After Percutaneous coronarY Intervention: The REMEDY Score.

Abstract

Background: A clinically applicable tool incorporating comprehensive risk factors to evaluate long-term hard endpoints post-percutaneous coronary intervention (PCI) is currently lacking.

Aims: This study aims to develop a risk score from a large contemporary cohort to assess and stratify long-term risk of major adverse cardiac and cerebrovascular events (MACCEs) post-PCI, enabling proactive management and monitoring in high-risk patients.

Methods: The study prospectively enrolled 28,683 consecutive patients undergoing PCI from 2017 to 2018, assigning the first 70% for score derivation and the remaining 30% for validation. The primary endpoint was 3-year MACCEs, including cardiovascular death, myocardial infarction, and stroke. A LASSO-Cox model identified 10 independent predictors, from which a weighted integer scoring system was developed.

Results: Within 3 years post-PCI, 1013 MACCEs (3.5%) were observed. A risk score incorporating three demographic factors (age, severe coronary artery disease history, hypertension duration), two clinical characteristics (left ventricular ejection fraction, clinical presentation), two angiographic features (affected vessels, calcification severity), and three laboratory results (glycated hemoglobin, N-terminal pro-B-type natriuretic peptide, estimated glomerular filtration rate) demonstrated strong predictive performance (c-index 0.764, AUC 0.831, goodness-of-fit p = 0.34). Patients were stratified into low (score 0-4, risk ≤ 2%), moderate (score 5-8, 2% < risk ≤ 5%), and high risk (score ≥ 9, risk > 5%), with corresponding 3-year MACCE incidences of 1.6%, 4.0%, and 10.1%.

Conclusions: A contemporary simple risk score integrating 10 readily available variables accurately predicts long-term hard outcomes in PCI patients, facilitating personalized risk assessment and informed treatment decisions.