Abstract 3919: Risk-Adjusted Mortality Analysis of Percutaneous Coronary Interventions by American College of Cardiology/American Heart Association Guidelines Recommendations
Background: Evidence-based guidelines improve quality of care and clinical outcomes. An ACC/AHA Task Force established guidelines with recommended indications for percutaneous coronary interventions (PCI), grouped into 4 classes: I, IIa, IIb, and III, based on risks and benefits. Separately, the ACC-NCDR has developed a risk-adjusted model for in-hospital mortality in PCI.
Methods: We tested the hypothesis that the 14 risk factors in the NCDR model would vary in frequency among the 4 indications classes, but expected mortality would approximate observed mortality for each class. We analyzed the ACC-NCDR PCI database from 1/1/2001–12/31/2004, excluding PCI done for STEMI. This yielded 559,273 PCI’s for analysis; they were grouped by indications class. In addition to the NCDR model, 2 other validated PCI mortality models were also used for comparison: University of Michigan (Mich), and New York State Reporting System (NYS). Expected mortalities were calculated with each model.
Results: Increasing frequencies of risk components in the NCDR model were noted progressively across the 4 indications classes from I to III. The largest increases were in impaired left ventricular function, left main and proximal LAD stenoses, lesion complexity, and age. Expected mortalities increased from Class I to Class III, and corresponded well with observed mortalities. (Figure⇓)
Conclusion: The NCDR risk-adjusted mortality model can be linked to the ACC/AHA PCI guidelines indications, and together produce mortality risk estimates that are close to actual observed values. These methods are potentially powerful analytic tools for evaluation of quality and appropriateness of PCI practice.