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(Circulation. 2003;107:1871.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Modeling and Risk Prediction in the Current Era of Interventional Cardiology

A Report From the National Heart, Lung, and Blood Institute Dynamic Registry

David R. Holmes, MD; Faith Selzer, PhD; Janet M. Johnston, PhD; Sheryl F. Kelsey, PhD; Richard Holubkov, PhD; Howard A. Cohen, MD; David O. Williams, MD; Katherine M. Detre, MD, DrPH

From the Mayo Clinic, Rochester, Minn (D.R.H., K.M.D.); the University of Pittsburgh, Pittsburgh, Pa (F.S., J.M.J., S.F.K.); the University of Utah, Salt Lake City, Utah (R.H.); the University of Pittsburgh Medical Center, Pittsburgh, Pa (H.A.C.); and Rhode Island Hospital, Providence, RI (D.O.W.).

Correspondence to David R. Holmes, Jr, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail dholmes{at}mayo.edu

Background— Validation of in-hospital mortality models after percutaneous coronary interventions using multicenter data remains limited.

Methods and Results— This study evaluated whether multivariable mortality models developed during the pre-stent era by New York State, American College of Cardiology (ACC)–National Cardiovascular Data Registry, Northern New England Cooperative Group, Cleveland Clinic Foundation, and the University of Michigan are relevant in patients undergoing percutaneous coronary intervention in the 1997 to 1999 National Heart, Lung, and Blood Institute Dynamic Registry. Of 4448 Dynamic Registry patients, 73% received 1 stent and 28% received a IIB/IIIA receptor inhibitor. In-hospital mortality occurred in 64 patients (1.4%). The New York state model predicted mortality in 69 patients (1.5%; 95% confidence bounds [CI], 0.89% to 1.70%); Northern New England predicted mortality in 60 patients (1.3%; 95% CI, 1.0% to 1.7%); and Cleveland Clinic predicted mortality in 76 patients (1.7%; 95% CI, 1.3% to 2.1%). Among high-risk subgroups, with these 3 models, observed and predicted in-hospital mortality rates in general were not different. The other 2 models yielded different results. The University of Michigan predicted fewer deaths (n=47; 1.1%; 95% CI, 0.7% to 1.3%), and the ACC Registry model predicted 603 deaths (13.5%; 95% CI, 12.6% to 14.4%). Using the ACC Registry model, predicted mortality was higher than observed in each subgroup.

Conclusions— Application of 5 mortality risk models developed from different data sets to patients undergoing percutaneous coronary intervention in the Dynamic Registry predicted, in 3 models, mortality rates that were not significantly different than those observed. In both high and low risk subgroups, the University of Michigan slightly underpredicted mortality, and the ACC Registry predicted significantly higher mortality than that observed.

Key Words: interventional cardiology • coronary disease • stents

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