(Circulation. 2001;104:263.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Simple Bedside Additive Tool for Prediction of In-Hospital Mortality After Percutaneous Coronary Interventions
From the Division of Cardiology (M.M., E.K.-R., K.A.E.), University of Michigan, Blue Cross Blue Shield of Michigan Cardiovascular Consortium Coordinating Center, Ann Arbor; Blue Cross Blue Shield Center for Health Care Quality (D.S.), Detroit; St. Joseph Mercy Hospital (M.O.), Ann Arbor; Spectrum Health (A.M.-E.), Grand Rapids; Northern Michigan Hospital (W.L.M.), Petoskey; Henry Ford Hospital (P.K.), Detroit; McLaren Regional Medical Center (A.C.D, J.L.C.), Flint; St. Joseph Hospital (K.P.), Pontiac; and Harper Hospital-Wayne State University (J.G.M.), Detroit, Mich.
Correspondence to Mauro Moscucci, MD, University of Michigan Medical Center, Taubman 3910, 1500 E Medical Ctr Dr, Ann Arbor, MI 48109-0022. E-mail moscucci{at}umich.edu
Background— Risk-adjustment models for percutaneous coronary intervention (PCI) mortality have been recently reported, but application in bedside prediction of prognosis for individual patients remains untested.
Methods and Results— Between July 1, 1997 and September 30, 1999, 10 796 consecutive procedures were performed in a consortium of 8 hospitals. Predictors of in-hospital mortality were identified by use of multivariate logistic regression analysis. The final model was validated by use of the bootstrap technique. Additional validation was performed on an independent data set of 5863 consecutive procedures performed between October 1, 1999, and August 30, 2000. An additive risk-prediction score was developed by rounding coefficients of the logistic regression model to the closest half-integer, and a visual bedside tool for the prediction of individual patient prognosis was developed. In this patient population, the in-hospital mortality rate was 1.6%. Multivariate regression analysis identified acute myocardial infarction, cardiogenic shock, history of cardiac arrest, renal insufficiency, low ejection fraction, peripheral vascular disease, lesion characteristics, female sex, and advanced age as independent predictors of death. The model had excellent discrimination (area under the receiver operating characteristic curve, 0.90) and was accurate for prediction of mortality among different subgroups. Near-perfect correlation existed between calculated scores and observed mortality, with higher scores associated with higher mortality.
Conclusions— Accurate predictions of individual patient risk of mortality associated with PCI can be achieved with a simple bedside tool. These predictions could be used during discussions of prognosis before and after PCI.
Key Words: angioplasty • risk factors • coronary disease
This article has been cited by other articles:
 |
|
 |
|
  H. S. Gurm, D. E. Smith, J. S. Collins, D. Share, A. Riba, A. J. Carter, T. LaLonde, E. Kline-Rogers, M. O'Donnell, H. Changezi, et al. The relative safety and efficacy of abciximab and eptifibatide in patients undergoing primary percutaneous coronary intervention insights from a large regional registry of contemporary percutaneous coronary intervention. J. Am. Coll. Cardiol., February 5, 2008; 51(5): 529 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Singh, B. J. Gersh, S. Li, J. S. Rumsfeld, J. A. Spertus, S. M. O'Brien, R. M. Suri, and E. D. Peterson Mayo Clinic Risk Score for Percutaneous Coronary Intervention Predicts In-Hospital Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery Circulation, January 22, 2008; 117(3): 356 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. King III, T. Aversano, W. L. Ballard, R. H. Beekman III, M. J. Cowley, S. G. Ellis, D. P. Faxon, E. L. Hannan, J. W. Hirshfeld Jr, A. K. Jacobs, et al. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures) J. Am. Coll. Cardiol., July 3, 2007; 50(1): 82 - 108. [Full Text] [PDF]
|
|
|
|
 |
|
 A Siotia and J Gunn Risk scoring for percutaneous coronary intervention: let's do it! Heart, November 1, 2006; 92(11): 1539 - 1540. [Full Text] [PDF]
|
|
|
|
|
|
A D Grayson, R K Moore, M Jackson, S Rathore, S Sastry, T P Gray, I Schofield, A Chauhan, F F Ordoubadi, B Prendergast, et al. Multivariate prediction of major adverse cardiac events after 9914 percutaneous coronary interventions in the north west of England Heart, May 1, 2006; 92(5): 658 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Matheny, L. Ohno-Machado, and F. S. Resnic Monitoring Device Safety in Interventional Cardiology J. Am. Med. Inform. Assoc., March 1, 2006; 13(2): 180 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Moscucci, E. K. Rogers, C. Montoye, D. E. Smith, D. Share, M. O'Donnell, A. Maxwell-Eward, W. L. Meengs, A. C. De Franco, K. Patel, et al. Association of a Continuous Quality Improvement Initiative With Practice and Outcome Variations of Contemporary Percutaneous Coronary Interventions Circulation, February 14, 2006; 113(6): 814 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Wu, E. L. Hannan, G. Walford, J. A. Ambrose, D. R. Holmes Jr, S. B. King III, L. T. Clark, S. Katz, S. Sharma, and R. H. Jones A Risk Score to Predict In-Hospital Mortality for Percutaneous Coronary Interventions J. Am. Coll. Cardiol., February 7, 2006; 47(3): 654 - 660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr, P. Hodgson, and M. Singh Guidelines, Lighthouses, and a Toe in the Water Circulation, November 1, 2005; 112(18): 2754 - 2755. [Full Text] [PDF]
|
|
|
|
|
|
M. Moscucci, D. Share, D. Smith, M. J. O'Donnell, A. Riba, R. McNamara, T. Lalonde, A. C. Defranco, K. Patel, E. Kline Rogers, et al. Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice: An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database J. Am. Coll. Cardiol., August 16, 2005; 46(4): 625 - 632. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Brinker, C. J. Davidson, and W. Laskey Preventing in-hospital cardiac and renal complications in high-risk PCI patients Eur. Heart J. Suppl., August 1, 2005; 7(suppl_G): G13 - G24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Moscucci, K. A. Eagle, D. Share, D. Smith, A. C. De Franco, M. O'Donnell, E. Kline-Rogers, S. M. Jani, and D. L. Brown Public Reporting and Case Selection for Percutaneous Coronary Interventions: An Analysis From Two Large Multicenter Percutaneous Coronary Intervention Databases J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1759 - 1765. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Vanholder, Z. Massy, A. Argiles, G. Spasovski, F. Verbeke, N. Lameire, and for the European Uremic Toxin Work Group (EUTox) Chronic kidney disease as cause of cardiovascular morbidity and mortality Nephrol. Dial. Transplant., June 1, 2005; 20(6): 1048 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. S. Resnic, K. H. Zou, D. V. Do, G. Apostolakis, and L. Ohno-Machado Exploration of a Bayesian Updating Methodology to Monitor the Safety of Interventional Cardiovascular Procedures Med Decis Making, August 1, 2004; 24(4): 399 - 407. [Abstract] [PDF]
|
|
|
|
|
|
M. Singh, C. S. Rihal, R. J. Lennon, K. N. Garratt, and D. R. Holmes Jr Comparison of Mayo Clinic risk score and American College of Cardiology/American Heart Association lesion classification in the prediction of adverse cardiovascular outcome following percutaneous coronary interventions J. Am. Coll. Cardiol., July 21, 2004; 44(2): 357 - 361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. McKechnie, D. Smith, C. Montoye, E. Kline-Rogers, M. J. O'Donnell, A. C. DeFranco, W. L. Meengs, R. McNamara, J. G. McGinnity, K. Patel, et al. Prognostic Implication of Anemia on In-Hospital Outcomes After Percutaneous Coronary Intervention Circulation, July 20, 2004; 110(3): 271 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Eagle, M. J. Lim, O. H. Dabbous, K. S. Pieper, R. J. Goldberg, F. Van de Werf, S. G. Goodman, C. B. Granger, P. G. Steg, J. M. Gore, et al. A Validated Prediction Model for All Forms of Acute Coronary Syndrome: Estimating the Risk of 6-Month Postdischarge Death in an International Registry JAMA, June 9, 2004; 291(22): 2727 - 2733. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Qureshi, R. D. Safian, C. L. Grines, J. A. Goldstein, D. C. Westveer, S. Glazier, M. Balasubramanian, and W. W. O'Neill Simplified scoring system for predicting mortality after percutaneous coronary intervention J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1890 - 1895. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Cutlip, K. K. L. Ho, R. E. Kuntz, and D. S. Baim Risk assessment for percutaneous coronary intervention: our version of the weather report? J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1896 - 1899. [Full Text] [PDF]
|
|
|
|
|
|
M. Singh, C. S. Rihal, F. Selzer, K. E. Kip, K. Detre, and D. R. Holmes Jr Validation of Mayo clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1722 - 1728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. de Feyter and E. McFadden Risk score for percutaneous coronary intervention: forewarned is forearmed J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1729 - 1730. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Moscucci, K.A.A. Fox, C. P. Cannon, W. Klein, J. Lopez-Sendon, G. Montalescot, K. White, R.J. Goldberg, and for the GRACE Investigators Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE) Eur. Heart J., October 2, 2003; 24(20): 1815 - 1823. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes, F. Selzer, J. M. Johnston, S. F. Kelsey, R. Holubkov, H. A. Cohen, D. O. Williams, and K. M. Detre Modeling and Risk Prediction in the Current Era of Interventional Cardiology: A Report From the National Heart, Lung, and Blood Institute Dynamic Registry Circulation, April 15, 2003; 107(14): 1871 - 1876. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Predicting Post-PCI In-Hospital Mortality Journal Watch Cardiology, September 14, 2001; 2001(914): 6 - 6. [Full Text]
|
|