Prediction of Long Term Mortality after Percutaneous Coronary Intervention in Older Adults: Results from the National Cardiovascular Data Registry
Background—The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention (PCI) both in patients with ST elevation myocardial infarction (STEMI) and those with more stable coronary disease.
Methods and Results—The American College of Cardiology Foundation CathPCI Registry® data was linked to the Centers for Medicare and Medicaid Services (CMS) 100% denominator file by probabilistic matching. Pre-procedure demographic and clinical variables from the CathPCI registry were used to predict the probability of death over three years as recorded in the CMS database. Between 2004 and 2007, 343,466 patients (66%) of 518,195 patients age 65 or older undergoing first PCI in the CathPCI Registry were successfully linked to CMS data. This study population was randomly divided into 60% derivation and 40% validation cohorts. Median follow-up was 15 months, with mortality of 3.0% at 30 days, and 8.6%, 13.4% and 18.3% at 1, 2 and 3 years, respectively. Twenty-four characteristics related to demographics, clinical co-morbidity, prior history of disease, as well as indices of disease severity and acuity, were identified as being associated with mortality. The c indices in the validation cohorts for patients with and without STEMI were 0.79 and 0.78. The model calibrated well across a wide range of predicted probabilities.
Conclusions—Based on the large and nationally representative CathPCI Registry, we have developed a model that has excellent discrimination, calibration and validation to predict survival up to three years after PCI.
- Received September 8, 2011.
- Accepted January 30, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited