The Ongoing Evolution of Outcomes Analysis for Pediatric and Congenial Cardiac Catheterization
Jayaram and colleagues are to be congratulated for their important manuscript in this issue of Circulation.1 The IMPACTTM Registry (IMproving Pediatric and Adult Congenital Treatment) of the National Cardiovascular Data Registry (NCDR) of the American College of Cardiology (ACC) is the largest registry, to date, collecting information on pediatric and adult patients with congenital heart disease undergoing diagnostic or interventional cardiac catheterization. Jayaram and colleagues used the IMPACTTM Registry to develop and internally validate a model to predict the occurrence of a major adverse event following cardiac catheterization, using a cohort of 19,608 cardiac catheterizations that were performed at 58 U.S. centers between January 2011 and March 2013. A major adverse event occurred in 378 (1.9%) of all cases. After multivariable adjustment, eight variables were identified as critical for risk-standardization: patient age, renal insufficiency, single-ventricle physiology, procedure-type risk group, low systemic saturation, low mixed venous saturation, elevated systemic ventricular end diastolic pressure, and elevated main pulmonary artery pressures. The model had good discrimination (C-statistic of 0.70), confirmed by bootstrap validation (validation C-statistic of 0.69).
- Received September 18, 2015.
- Revision received October 8, 2015.
- Accepted October 8, 2015.