Long-term prognostic value of QRS score in patients with successfully recanalized coronary chronic total occlusion and construction of a predictive nomogram model

• Published in: International journal of cardiology 2017-01, Vol.227, p.698-703
• Main Authors: Xie, Hao, Chen, Li-ming, Sun, Hai-hui, Li, Lin, Liu, Hang, Li, Wen-jia, Jiang, Jian-bang, Cui, Lian-qun
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Chronic Disease; Chronic total occlusion; Coronary Angiography - trends; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - physiopathology; Electrocardiography - trends; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nomogram; Nomograms; Predictive Value of Tests; Prognosis; Prognostic; QRS score; Retrospective Studies; Severity of Illness Index; Time Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.10.075

Abstract Background Few studies have evaluated the prognostic value of QRS score in patients with coronary chronic total occlusion (CTO) after successful recanalization. Methods A total of 474 patients with successfully recanalized coronary CTO were finally included in our study and were followed up for 34.0 ± 5.3 months. They were divided into 3 groups: QRS score ≥ 8, QRS score 4–7 and QRS score 0–3. The primary outcome was composite endpoint of major adverse cardiac and cerebral events (MACCEs). A predictive nomogram was established to predict prognosis for MACCEs, and the predictive accuracy of the nomogram was determined by concordance index. Results We found that QRS score correlated moderately with wall motion score index (WMSI) (r = 0.551, p < 0.001), left ventricular ejection fraction (LVEF) (r = − 0.339, p < 0.001) and coronary collateral circulation (CCC) (r = − 0.569, p < 0.001). During follow-up, patients with higher QRS score were observed to undergo poor prognosis. After multivariable adjustment, QRS score was still a significant independent predictor for MACCEs [(hazard ratio 1.28 , 95% CI 1.18–1.39, p < 0.001) in model 1,(hazard ratio 1.30 , 95% CI 1.21–1.41, p < 0.001) in mode2] and mortality[(hazard ratio 1.33, 95% CI 1.14–1.57, p < 0.001) in model 1, (hazard ratio 1.49 , 95% CI 1.24–1.79, p < 0.001) in model 2],. Moreover, the nomogram could more accurately predict 3-year MACCEs (c-index: 0.84). Conclusion QRS score is a strong independent predictor of long-term prognosis in patients with coronary CTO successfully recancalized. The proposed nomograms can be used for the prediction of MACCE in this population.