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

Coronary interventions

Derivation and external validation of a novel risk score for prediction of 30-day mortality after percutaneous coronary intervention

EuroIntervention 2019;15:e551-e557. DOI: 10.4244/EIJ-D-19-00262

1. New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA; 2. NewYork-Presbyterian Columbia University Medical Center, 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; 6. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 7. Helios Amper-Klinikum, Dachau, Germany; 8. Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC, USA; 9. Ballad Health CVA Heart Institute, Kingsport, TN, USA; 10. The Ohio State University Wexner Medical Center, Columbus, OH, USA

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 Current risk prediction models for this event are outdated.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 randomised 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 tenfold 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.

Conclusions: A novel risk score incorporating eight 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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