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)
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)
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DOI：
10.1016/j.jcin.2013.03.020
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发表时间：
2013-08-01
影响因子：
11.3
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
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作者：
Brennan, J. Matthew;Curtis, Jeptha P.;Peterson, Eric D.
Objectives本研究旨在更新和验证经皮冠状动脉介入治疗（PCI）后住院死亡率的当代模型，包括表明高临床风险的变量。这种修改使我们能够更好地描述死亡的风险，包括最近的心脏骤停和心源性shock.Methods从2009年7月至2011年6月在1,252 CathPCI注册网站进行的1,208,137 PCI程序的数据被用来开发一个“完整的”和术前导管PCI住院死亡率风险模型，使用logistic回归。为了支持前瞻性实施，根据导管插入前风险模型推导出简化的床旁风险评分。模型的性能进行了评估的歧视和校准指标在一个单独的分裂sample.Results住院死亡率为1.4%，范围从0.2%之间的选修病例（45.1%的总病例），休克和最近的心脏骤停患者（0.2%的总病例）的65.9%。心源性休克和手术紧迫性是住院死亡率的最佳预测因素，而慢性完全闭塞、亚急性支架内血栓形成和左主干病变位置是重要的血管造影预测因素。完整、导管插入前和床旁风险预测模型在总体验证样本（C指数分别为0.930、0.928、0.925）和预先指定的患者亚组中表现良好。该模型在整个风险谱中得到了很好的校准，尽管在最高风险patients. Conclusions中略微高估了风险，但临床敏锐度是PCI手术死亡率的一个强有力的预测因素。通过纳入进一步表征临床稳定性的变量，更新的CathPCI登记研究死亡率模型在PCI风险范围内保持良好校准。(C)2013年美国心脏病学会基金会
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. (C) 2013 by the American College of Cardiology Foundation