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CLINICAL STUDY

Correlates of procedural complicationsand a simple integer risk scorefor percutaneous coronary intervention

Mandeep Singh, MD^*, Ryan J. Lennon, MS, David R. Holmes, Jr, MD, FACC^*, Malcolm R. Bell, MB, BS, FRACP, FACC^* and Charanjit S. Rihal, MD, FACC^*,*

^* Division of Cardiovascular Diseases and Internal MedicineRochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received September 6, 2001; revised manuscript received March 25, 2002, accepted April 30, 2002.

^* Reprint requests and correspondence: Dr. Charanjit S. Rihal, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
rihal{at}mayo.edu

OBJECTIVES: Our goals were to identify clinical and angiographic risk factors associated with major cardiovascular complications of percutaneous coronary intervention (PCI) (in-hospital death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass surgery and stroke) and to construct a simple score for risk stratification.

BACKGROUND: Both clinical and angiographic features influence risk of PCIs.

METHODS: Percutaneous coronary interventions performed between January 1, 1996, and December 31, 1999, were analyzed. Logistic regression and bootstrap methods were used to create an integer risk score for estimating the risk of procedural complications using baseline, angiographic and procedural characteristics. The risk score was tested in a validation-set consisting of all procedures performed in the year 2000.

RESULTS: Among 5,463 procedures, 5 clinical and 3 angiographic variables were significantly correlated with procedural complications: cardiogenic shock, left main coronary artery disease, severe renal disease, urgent or emergent procedure, congestive heart failure class III or higher, thrombus, multivessel disease and older age. In the validation-set, the model fitted the data adequately; the average receiver operating characteristic curve area was 0.782 (standard deviation, 0.018).

CONCLUSIONS: Eight variables were combined into a convenient bedside risk scoring system that estimates the risk of complications after PCIs.

Abbreviations and Acronyms   ACC/AHA   American College of Cardiology/American Heart Association   CABG   coronary artery bypass graft surgery   GP   glycoprotein   MI   myocardial infarction   NYHA   New York Heart Association   PCI   percutaneous coronary intervention   ROC   receiver operating characteristic

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