Contemporary Mortality Risk Prediction for Percutaneous Coronary Intervention: Results from 588,398 Procedures in the National Cardiovascular Data Registry

Overview

Journal J Am Coll Cardiol

Specialty Cardiology & Vascular Diseases

Date 2010 May 1

PMID 20430263

Citations 115

Authors

Eric D Peterson

David Dai

Elizabeth R DeLong

J Matthew Brennan

Mandeep Singh

Sunil V Rao

Richard E Shaw

Matthew T Roe

Kalon K L Ho

Lloyd W Klein

Ronald J Krone

William S Weintraub

Ralph G Brindis

John S Rumsfeld

John A Spertus

Affiliations

Soon will be listed here.

Abstract

Objectives: We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI).

Background: There is a need to identify PCI risk factors and accurately quantify procedural risks to facilitate comparative effectiveness research, provider comparisons, and informed patient decision making.

Methods: Data from 181,775 procedures performed from January 2004 to March 2006 were used to develop risk models based on pre-procedural and/or angiographic factors using logistic regression. These models were independently evaluated in 2 validation cohorts: contemporary (n = 121,183, January 2004 to March 2006) and prospective (n = 285,440, March 2006 to March 2007).

Results: Overall, PCI in-hospital mortality was 1.27%, ranging from 0.65% in elective PCI to 4.81% in ST-segment elevation myocardial infarction patients. Multiple pre-procedural clinical factors were significantly associated with in-hospital mortality. Angiographic variables provided only modest incremental information to pre-procedural risk assessments. The overall National Cardiovascular Data Registry (NCDR) model, as well as a simplified NCDR risk score (based on 8 key pre-procedure factors), had excellent discrimination (c-index: 0.93 and 0.91, respectively). Discrimination and calibration of both risk tools were retained among specific patient subgroups, in the validation samples, and when used to estimate 30-day mortality rates among Medicare patients.

Conclusions: Risks for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools should facilitate research, clinical decisions, and policy applications.

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