期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 78, 期 3, 页码 216-229出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2021.04.067
关键词
percutaneous coronary intervention; risk-standardized mortality rates; hierarchical logistic regression model
资金
- American College of Cardiology Foundation's National Cardiovascular Data Registry
- Philips Medical Systems
- Novartis
- Boehringer Ingelheim
- Amgen
- AstraZeneca
- CSL Behring
- American College of Cardiology
This study developed a model for predicting in-hospital mortality risk following PCI, incorporating additional variables. The results suggested that in-hospital mortality following PCI varies based on clinical presentation.
BACKGROUND Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCIs). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients. OBJECTIVES This study sought to develop a model for predicting in-hospital mortality risk following PCI incorporating these additional variables. METHODS Data from 706,263 PCIs performed between July 2018 and June 2019 at 1,608 sites were used to develop and validate a new full and pre-catheterization model to predict in-hospital mortality, and a simplified bedside risk score. The sample was randomly split into a development cohort (70%, n = 495,005) and a validation cohort (30%, n = 211,258). The authors created 1,000 bootstrapped samples of the development cohort and used stepwise selection logistic regression on each sample. The final model included variables that were selected in at least 70% of the boot-strapped samples and those identified a priori due to clinical relevance. RESULTS In-hospital mortality following PCI varied based on clinical presentation. Procedural urgency, cardiovascular instability, and level of consciousness after cardiac arrest were most predictive of in-hospital mortality. The full model performed well, with excellent discrimination (C-index: 0.943) in the validation cohort and good calibration across different clinical and procedural risk cohorts. The median hospital risk-standardized mortality rate was 1.9% and ranged from 1.1% to 3.3% (interquartile range: 1.7% to 2.1%). CONCLUSIONS The risk of mortality following PCI can be predicted in contemporary practice by incorporating variables that reflect clinical acuity. This model, which includes data previously not captured, is a valid instrument for risk strat-ification and for quality improvement efforts. (J Am Coll Cardiol 2021;78:216-29) (c) 2021 by the American College of Cardiology Foundation. RESULTS In-hospital mortality following PCI varied based on clinical presentation. Procedural urgency, cardiovascular instability, and level of consciousness after cardiac arrest were most predictive of in-hospital mortality. The full model performed well, with excellent discrimination (C-index: 0.943) in the validation cohort and good calibration across different clinical and procedural risk cohorts. The median hospital risk-standardized mortality rate was 1.9% and ranged
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据