Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry).JACC Cardiovasc Interv 2013; 6(8):790-9JC
Abstract
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.
MeSH
AgedAged, 80 and overCoronary AngiographyCoronary Artery DiseaseDiscriminant AnalysisFemaleHeart ArrestHospital MortalityHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPercutaneous Coronary InterventionRegistriesReproducibility of ResultsRisk AssessmentRisk FactorsShock, CardiogenicTime FactorsTreatment OutcomeUnited States
Pub Type(s)
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Validation Study
Language
eng
PubMed ID
23968699
Citation
Brennan, J Matthew, et al. "Enhanced Mortality Risk Prediction With a Focus On High-risk Percutaneous Coronary Intervention: Results From 1,208,137 Procedures in the NCDR (National Cardiovascular Data Registry)." JACC. Cardiovascular Interventions, vol. 6, no. 8, 2013, pp. 790-9.
Brennan JM, Curtis JP, Dai D, et al. Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 2013;6(8):790-9.
Brennan, J. M., Curtis, J. P., Dai, D., Fitzgerald, S., Khandelwal, A. K., Spertus, J. A., ... Peterson, E. D. (2013). Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry). JACC. Cardiovascular Interventions, 6(8), pp. 790-9. doi:10.1016/j.jcin.2013.03.020.
Brennan JM, et al. Enhanced Mortality Risk Prediction With a Focus On High-risk Percutaneous Coronary Intervention: Results From 1,208,137 Procedures in the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 2013;6(8):790-9. PubMed PMID: 23968699.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: 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,
AU - ,,
PY - 2012/07/24/received
PY - 2013/03/12/revised
PY - 2013/03/15/accepted
PY - 2013/8/24/entrez
PY - 2013/8/24/pubmed
PY - 2014/3/25/medline
KW - American College of Cardiology
KW - BMI
KW - CI
KW - DCF v4
KW - EF
KW - GFR
KW - IQR
KW - National Cardiovascular Data Registry CathPCI Registry
KW - OR
KW - PCI
KW - ST-segment elevation myocardial infarction
KW - STEMI
KW - Version 4 CathPCI Registry data clarification form
KW - body mass index
KW - confidence interval
KW - ejection fraction
KW - glomerular filtration rate
KW - interquartile range
KW - odds ratio
KW - percutaneous coronary intervention
KW - risk prediction
SP - 790
EP - 9
JF - JACC. Cardiovascular interventions
JO - JACC Cardiovasc Interv
VL - 6
IS - 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.
SN - 1876-7605
UR - https://www.unboundmedicine.com/medline/citation/23968699/Enhanced_mortality_risk_prediction_with_a_focus_on_high_risk_percutaneous_coronary_intervention:_results_from_1208137_procedures_in_the_NCDR__National_Cardiovascular_Data_Registry__
L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)00982-5
DB - PRIME
DP - Unbound Medicine
ER -
