Abstract 11849: Validating and Updating the Toronto In-Hospital Mortality Risk Score After Percutaneous Coronary Interventions in Brazil
Background: Estimating percutaneous coronary intervention (PCI) mortality risk by a clinical prediction model is imperative to help physicians, patients and family members make informed clinical decisions and optimize participation in the consent process, reducing anxiety and improving quality of care. At a healthcare system level, risk prediction scores are essential to measure and benchmark performance.
Hypothesis: The Toronto PCI mortality risk score is accurate and precise in predicting death in a Brazilian population.
Methods: Between 2009 and 2013, a cohort of 4,806 patients from the ICP-BR registry, treated with PCI in eight tertiary referral medical centers, was included in the analysis. This population was compared to 10,694 patients of the derivation dataset from the Toronto study. To assess predictive performance, an update of the model was performed by three different methods, which were compared by discrimination, calculating the area under the receiver operating characteristic curve (AUC), and by calibration, assessed through Hosmer-Lemeshow (H-L) test and graphical analysis. The score included the following predictors: age - 40-49 (1), 50-59 (2), 60-69 (3), 70-79 (4) and ≥80 (5); diabetes (2); renal failure (2), NYHA class IV heart failure symptoms (3); severe myocardial dysfunction (3); multivessel disease (1), left main disease (2); recent myocardial infarction (3); early PCI after thrombolysis (3); primary PCI (4); cardiogenic shock (6). After summing the score values we apply the equation: 1/(1+e^(- (-7.448 + risk score x 0.352))). We sought to re-divide the integer score according to the predictive risk in low (<1% - score 0 - 8), moderate (1-5% - score 9 - 12) and high (>5% - score ≥13) risk groups.
Results: Death occurred in 2.6% of patients in the ICP-BR registry and in 1.3% in the Toronto cohort. The median age was 64 and 63 years, 23.8 and 32.8% were female, 28.6 and 32.3% were diabetics, respectively. Through recalibration of intercept and slope (AUC= 0.8790; H-L p value= 0.3132), we achieved a well-calibrated and well-discriminative model.
Conclusions: After updating to our dataset, we demonstrated that the Toronto PCI in-hospital mortality risk score has a good performance and discrimination in Brazilian hospitals.
Author Disclosures: L. Lodi-Junqueira: None. J.P. Silva: None. L.R. Ferreira: None. H.L. Oliveira: None. G.R. Athayde: None. T.O. Gomes: None. J.C. Borges: None. B.R. Nascimento: None. E.A. Colosimo: None. P.A. Lemos: None. A.L. Ribeiro: None.
- © 2014 by American Heart Association, Inc.