TY - JOUR
T1 - Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention
T2 - Results from 1,208,137 procedures in the NCDR (national cardiovascular data registry)
AU - Brennan, J. Matthew
AU - Curtis, Jeptha P.
AU - Dai, David
AU - Fitzgerald, Susan
AU - Khandelwal, Akshay K.
AU - Spertus, John A.
AU - Rao, Sunil V.
AU - Singh, Mandeep
AU - Shaw, Richard E.
AU - Ho, Kalon K.L.
AU - Krone, Ronald J.
AU - Weintraub, William S.
AU - Weaver, W. Douglas
AU - Peterson, Eric D.
N1 - Funding Information:
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR) . The views expressed in this manuscript represent those of the author(s), and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com . Dr. Curtis has received salary support from the American College of Cardiology and Centers for Medicare & Medicaid Services ; he also owns stock in Medtronic. Dr. Khandelwal has received consulting fees from Terumo Medical Corp. Dr. Spertus has received consulting fees from the American College of Cardiology Foundation for the analysis of NCDR data. Dr. Weaver has served on the Data and Safety Monitoring Board of Boston Scientific. Dr. Peterson has received consulting fees from Janssen Pharmaceuticals, Boehringer Ingelheim, Pfizer, and Eli Lilly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/8
Y1 - 2013/8
N2 - Objectives This study sought to update and validate a contemporary model for inpatient mortality following percutaneous coronary intervention (PCI), including variables indicating high clinical risk. Background Recently, new variables were added to the CathPCI Registry data collection form. This modification allowed us to better characterize the risk of death, including recent cardiac arrest and duration of cardiogenic shock. Methods Data from 1,208,137 PCI procedures performed between July 2009 and June 2011 at 1,252 CathPCI Registry sites were used to develop both a "full" and pre-catheterization PCI in-hospital mortality risk model using logistic regression. To support prospective implementation, a simplified bedside risk score was derived from the pre-catheterization risk model. Model performance was assessed by discrimination and calibration metrics in a separate split sample. Results In-hospital mortality was 1.4%, ranging from 0.2% among elective cases (45.1% of total cases) to 65.9% among patients with shock and recent cardiac arrest (0.2% of total cases). Cardiogenic shock and procedure urgency were the most predictive of inpatient mortality, whereas the presence of a chronic total occlusion, subacute stent thrombosis, and left main lesion location were significant angiographic predictors. The full, pre-catheterization, and bedside risk prediction models performed well in the overall validation sample (C-indexes 0.930, 0.928, 0.925, respectively) and among pre-specified patient subgroups. The model was well calibrated across the risk spectrum, although slightly overestimating risk in the highest risk patients. Conclusions Clinical acuity is a strong predictor of PCI procedural mortality. With inclusion of variables that further characterize clinical stability, the updated CathPCI Registry mortality models remain well-calibrated across the spectrum of PCI risk.
AB - Objectives This study sought to update and validate a contemporary model for inpatient mortality following percutaneous coronary intervention (PCI), including variables indicating high clinical risk. Background Recently, new variables were added to the CathPCI Registry data collection form. This modification allowed us to better characterize the risk of death, including recent cardiac arrest and duration of cardiogenic shock. Methods Data from 1,208,137 PCI procedures performed between July 2009 and June 2011 at 1,252 CathPCI Registry sites were used to develop both a "full" and pre-catheterization PCI in-hospital mortality risk model using logistic regression. To support prospective implementation, a simplified bedside risk score was derived from the pre-catheterization risk model. Model performance was assessed by discrimination and calibration metrics in a separate split sample. Results In-hospital mortality was 1.4%, ranging from 0.2% among elective cases (45.1% of total cases) to 65.9% among patients with shock and recent cardiac arrest (0.2% of total cases). Cardiogenic shock and procedure urgency were the most predictive of inpatient mortality, whereas the presence of a chronic total occlusion, subacute stent thrombosis, and left main lesion location were significant angiographic predictors. The full, pre-catheterization, and bedside risk prediction models performed well in the overall validation sample (C-indexes 0.930, 0.928, 0.925, respectively) and among pre-specified patient subgroups. The model was well calibrated across the risk spectrum, although slightly overestimating risk in the highest risk patients. Conclusions Clinical acuity is a strong predictor of PCI procedural mortality. With inclusion of variables that further characterize clinical stability, the updated CathPCI Registry mortality models remain well-calibrated across the spectrum of PCI risk.
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U2 - 10.1016/j.jcin.2013.03.020
DO - 10.1016/j.jcin.2013.03.020
M3 - Article
C2 - 23968699
AN - SCOPUS:84882753131
SN - 1936-8798
VL - 6
SP - 790
EP - 799
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 8
ER -