Contemporary mortality risk prediction for percutaneous coronary intervention: Results from 588, 398 procedures in the national cardiovascular data registry
Objectives: We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI). Background: There is a need to identifiy 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 usind logistic regression. These models were independently evaluated in 2 validation cohorts: contempoarar7 (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-procedual 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 retaine among specific patient subgroups, in the validation samples, and when used to estimate 30-day mortality rates among Medicare patients. Conclusions: Risk, for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools schould facilitate research, clinical decisions, and policy applications.
Petersen, ED; Dai, D; Delong, ER
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