The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Derivation and External Validation of a Novel Risk Score for Prediction of 30-Day Mortality After Percutaneous Coronary Intervention

1. NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
2. NewYork-Presbyterian Columbia University Medical Center, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
3. Imperial College of Science, Technology and Medicine, London, United Kingdom
4. Maasstad Ziekenhuis, Rotterdam, the Netherlands
5. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
6. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
7. NewYork-Presbyterian Columbia University Medical Center, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
8. Helios Amper-Klinikum, Dachau, Germany
9. Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC, USA
10. Ballad Health CVA Heart Institute, Kingsport, TN, USA
11. The Ohio State University Wexner Medical Center, Columbus, OH, USA
12. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
13. NewYork-Presbyterian Columbia University Medical Center, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
14. NewYork-Presbyterian Columbia University Medical Center, New York, NY, USAl; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
15. Montefiore Medical Center, Bronx, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
16. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
17. CVA Brookwood Baptist Hospital, Birmingham, AL, USA
18. Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC, USA
19. LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
20. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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Aims: Early mortality after percutaneous coronary intervention (PCI) is relatively rare. Current risk prediction models for this event are outdated. We sought to derive a 30-day mortality risk score after PCI.

Methods and results: The score was derived from a pooled database of 21 randomized clinical trials using a logistic regression model incorporating clinical and angiographic variables. The score was validated in a separate unrestricted study population, the Assessment of Dual AntiPlatelet Therapy with Drug Eluting Stents (ADAPT-DES) registry. Of 32,882 eligible patients, 75% had data for all 19 variables used for score derivation. The independent predictors of 30-day mortality were age, presentation with ACS, diabetes mellitus, use of first-generation drug-eluting stents, left main or left anterior descending artery lesion, prior myocardial infarction (MI), and suboptimal flow in the artery before or after PCI. The median [interquartile range] score in the derivation cohort was 5 [3,6] and overall mortality was 0.49%, ranging from 0.08% to 1.64% with scores of 0-16. The 30-day mortality rate was approximately 10-fold higher in patients with a score at or above versus below the median of 5 (0.86% versus 0.08%, P<0.0001). Discrimination in both cohorts was very good (C statistic = 0.848 and 0.828, respectively), and calibration was satisfactory.

Conclusion: A novel risk score incorporating 8 readily available clinical and angiographic variables had high discrimination for 30-day death after PCI across a wide range of clinical scenarios.

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