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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Comparison of Mayo Clinic risk score and American College of Cardiology/American Heart Association lesion classification in the prediction of adverse cardiovascular outcome following percutaneous coronary interventions

Mandeep Singh, MD^*,*, Charanjit S. Rihal, MD^*, Ryan J. Lennon, MS, Kirk N. Garratt, MD^* and David R. Holmes, Jr, MD^*

^* Division of Cardiovascular Diseases and Internal Medicine, Rochester, Minnesota, USA
Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Manuscript received January 8, 2004; revised manuscript received March 18, 2004, accepted March 22, 2004.

^* Reprint requests and correspondence: Dr. Mandeep Singh, 200 2nd Street SW, Mayo Clinic, Rochester, Minnesota 55905, USA.
singh.mandeep{at}mayo.edu

OBJECTIVES: We compared American College of Cardiology/American Heart Association (ACC/AHA) lesion classification with the recently proposed Mayo Clinic risk score to predict complications following percutaneous coronary intervention (PCI).

BACKGROUND: The ability of the ACC/AHA classification system to predict complications following PCI has been modest. With the inclusion of patient demographics, acuity of presentation, and measure of left ventricular function, models with better discriminatory accuracy are presently available.

METHODS: The Mayo Clinic risk score is constructed by adding integer scores for the presence of eight variables. We mapped the lesion-specific risk levels to a patient level by counting the number of lesions in each class (A, B1, B2, C, and unknown).

RESULTS: In 5,064 PCIs, 183 patients (4%) had the primary end point (death, Q-wave myocardial infarction, stroke, emergency coronary artery bypass graft). Of the 7,632 treated lesions, 891 (12%) were unsuccessfully treated with PCI (residual stenosis >20%). The discriminatory ability of the Mayo Clinic risk score model for prediction of the primary end point, as measured by the c-statistic, was 0.78 (95% confidence interval [CI] 0.74 to 0.81). The Mayo Clinic risk score offered significantly better risk stratification than the ACC/AHA lesion classification counts (95% CI for c-statistic difference: 0.05 to 0.15). Regarding angiographic success, the ACC/AHA lesion classification was a better system (95% CI for c-statistic difference: –0.08 to –0.03 favoring ACC/AHA classification), although its absolute ability was modest (c = 0.58).

CONCLUSIONS: Mayo Clinic risk score offers significantly better prediction for cardiovascular complications than the ACC/AHA classification. However, lesion classification by ACC/AHA classification is a better predictor for angiographic success.

Abbreviations and Acronyms   ACC = American College of Cardiology   AHA = American Heart Association   CABG = coronary artery bypass graft   CI = confidence interval   MACE = major adverse cardiovascular events   MI = myocardial infarction   NHLBI = National Heart, Lung, and Blood Institute   NYHA = New York Heart Association   PCI = percutaneous coronary intervention   SCAI = Society for Cardiac Angiography and Interventions

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