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The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program.

Publication ,  Journal Article
Maynard, C; Rao, SV; Gregg, M; Phillips, RC; Reisman, M; Tucker, E; Goss, JR
Published in: J Invasive Cardiol
January 2009

Published mortality models for percutaneous coronary intervention (PCI), including the Clinical Outcomes Assessment Program (COAP) model, have not considered the effect of out-ofhospital cardiac arrest. The primary objective of this study was to determine if the inclusion of out-of-hospital cardiac arrest altered the COAP mortality model for PCI. The COAP PCI database contains extensive demographic, clinical, procedural and outcome information, including out-of-hospital cardiac arrest, which was added to the data collection form in 2006. This study included 15,586 consecutive PCIs performed in 31 Washington State hospitals in 2006. Using development and test sets, the existing COAP PCI logistic regression mortality model was examined to assess the effect of out-of-hospital arrest on in-hospital mortality. Overall, 2% of individuals undergoing PCI had cardiac arrest prior to hospital arrival. Among 8 hospitals with PCI volumes < 120 cases per year, 4 had cardiac arrest volumes that exceeded 10% of total volume, whereas none of the centers with > 120 cases per year did. In-hospital mortality was 19% in the arrest group and was 1.0% in remaining procedures (p < 0.0001). In the new multivariate model, out-of-hospital cardiac arrest was highly associated with mortality (odds ratio = 5.50; 95% confidence interval [CI] = 3.28-9.25). When evaluated in the test set, the new model had excellent discrimination (c-statistic = 0.89; 95% CI = 0.85-0.93). Out-of-hospital cardiac arrest is an important determinant of risk-adjusted in-hospital mortality for PCI, particularly for hospitals with low volumes and relatively high volumes of cardiac arrest cases.

Duke Scholars

Published In

J Invasive Cardiol

EISSN

1557-2501

Publication Date

January 2009

Volume

21

Issue

1

Start / End Page

1 / 5

Location

United States

Related Subject Headings

  • Washington
  • Predictive Value of Tests
  • Outpatients
  • Outcome Assessment, Health Care
  • Multivariate Analysis
  • Models, Statistical
  • Middle Aged
  • Male
  • Logistic Models
  • Humans
 

Citation

APA
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ICMJE
MLA
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Maynard, C., Rao, S. V., Gregg, M., Phillips, R. C., Reisman, M., Tucker, E., & Goss, J. R. (2009). The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program. J Invasive Cardiol, 21(1), 1–5.
Maynard, Charles, Sunil V. Rao, Mary Gregg, Richard C. Phillips, Mark Reisman, Eben Tucker, and J Richard Goss. “The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program.J Invasive Cardiol 21, no. 1 (January 2009): 1–5.
Maynard C, Rao SV, Gregg M, Phillips RC, Reisman M, Tucker E, et al. The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program. J Invasive Cardiol. 2009 Jan;21(1):1–5.
Maynard C, Rao SV, Gregg M, Phillips RC, Reisman M, Tucker E, Goss JR. The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program. J Invasive Cardiol. 2009 Jan;21(1):1–5.

Published In

J Invasive Cardiol

EISSN

1557-2501

Publication Date

January 2009

Volume

21

Issue

1

Start / End Page

1 / 5

Location

United States

Related Subject Headings

  • Washington
  • Predictive Value of Tests
  • Outpatients
  • Outcome Assessment, Health Care
  • Multivariate Analysis
  • Models, Statistical
  • Middle Aged
  • Male
  • Logistic Models
  • Humans