Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry.
Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry.
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DOI：
10.1016/j.jacc.2010.02.005
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发表时间：
2010-05-04
影响因子：
24
通讯作者：
Spertus, John A.
中科院分区：
文献类型：
--
作者：
Peterson, Eric D.;Dai, David;DeLong, Elizabeth R.;Brennan, J. Matthew;Singh, Mandeep;Rao, Sunil V.;Shaw, Richard E.;Roe, Matthew T.;Ho, Kalon K. L.;Klein, Lloyd W.;Krone, Ronald J.;Weintraub, William S.;Brindis, Ralph G.;Rumsfeld, John S.;Spertus, John A.
我们试图创建现代模型来预测经皮冠状动脉介入治疗（PCI）后的死亡风险。需要识别 PCI 风险因素并准确量化程序风险，以促进比较有效性研究、提供商比较和患者知情决策。 2004 年 1 月至 2006 年 3 月期间进行的 181,775 例手术的数据被用于使用逻辑回归开发基于手术前和/或血管造影因素的风险模型。这些模型在两个验证队列中进行了独立评估：当代（n=121,183，2004年1月至2006年3月）和前瞻性（n=285,440，2006年3月至2007年3月）。总体而言，PCI 院内死亡率为 1.27%，范围从择期 PCI 的 0.65% 到 STEMI 患者的 4.81%。多种术前临床因素与院内死亡率显着相关。血管造影变量仅为术前风险评估提供适度的增量信息。整体 NCDR 模型以及简化的 NCDR 风险评分（基于 8 个关键的术前因素）具有出色的区分度（c 指数分别为 0.93 和 0.91）。两种风险工具的区分和校准均保留在特定患者亚组、验证样本中以及用于估计 Medicare 患者 30 天死亡率时。在当代实践中可以准确预测 PCI 后早期死亡的风险。此类风险工具的纳入应促进研究、临床和政策应用。
We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI). 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. 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 two validation cohorts: contemporary (n=121,183, January 2004 to March 2006) and prospective (n=285,440, March 2006 to March 2007). Overall, PCI in-hospital mortality was 1.27%, ranging from 0.65% in elective PCI to 4.81% in STEMI 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 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. Risks for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools should facilitate research, clinical, and policy applications.
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影响因子：
2.8
作者：
Klein, LW;Shaw, RE;Weintraub, WS
通讯作者：
Weintraub, WS
影响因子：
24
作者：
Singh, Mandeep;Rihal, Charanjit S.;Holmes, David R., Jr.
通讯作者：
Holmes, David R., Jr.
影响因子：
4.8
作者：
Hammill, Bradley G.;Hernandez, Adrian F.;Curtis, Lesley H.
通讯作者：
Curtis, Lesley H.
DOI：
10.1016/s0735-1097(02)02537-8
发表时间：
2002-12-04
影响因子：
24
作者：
Califf, RM;Peterson, ED;Smith, SC
通讯作者：
Smith, SC
DOI：
10.1016/s0735-1097(01)01372-9
发表时间：
2001-06-15
影响因子：
24
作者：
Brindis, R G;Fitzgerald, S;Williams, J F
通讯作者：
Williams, J F