Abstract 14082: Does the National Cardiovascular Data Registry Bleeding Risk Score Accurately Predict Bleeding in African American Patients Undergoing Percutaneous Coronary Intervention?
Background: The National Cardiovascular Data Registry (NCDR) risk score was validated to predict post-percutaneous coronary intervention (PCI) bleeding. However, this risk prediction model was derived from a predominantly Caucasian population, with an under-represented African American (AA) population of 6%. Differential post-PCI bleeding rates have been reported.
Objectives: We aim to analyze the post-PCI bleeding events in a better-represented AA population, and to determine if the NCDR bleeding risk model is improved by the addition of AA race to predict post-PCI bleeding.
Methods: From our own PCI registry, bleeding (defined by NCDR CathPCI registry as transfusion, prolonged hospital stay and/or drop in hemoglobin >3g/dL) rates were compared between AA and non-AA patients. A logistic regression model using ROC curves was used to compare the accuracy of the NCDR risk score in predicting post-PCI bleed in AA and non-AA patients, and a net reclassification improvement (NRI) analysis was used to determine if the model’s predictive ability was enhanced by adding AA race as a variable.
Results: A total of 22438 PCI patients were evaluated, of which 6396 (28.5%) were AA. Although NCDR bleeding risk score was higher in AA than in non-AA [median (IQR) 13 (8-18) vs 11 (6-17), p <0.001], overall observed bleeding event rates were similar (5.0% vs. 5.6%, p=NS). Observed bleeding event rates across risk scores are presented in Figure 1. The NCDR model predicted post-PCI bleeding similarly in AA and non-AA (AUC 0.68 vs 0.72, p=0.09) (Figure 2), and the model’s predictability was not enhanced by adding AA race as a variable using NRI analysis (NRI 4.8%, p=0.20).
Conclusion: The predicted post-PCI bleeding risk was higher in AA compared to non-AA; however, observed bleeding rates were similar. The NCDR bleeding risk score remained predictive of post-PCI bleed in both groups.
- © 2013 by American Heart Association, Inc.