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J Am Coll Cardiol, 2006; 47:654-660, doi:10.1016/j.jacc.2005.09.071 (Published online 28 December 2005).
© 2005 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

A Risk Score to Predict In-Hospital Mortality for Percutaneous Coronary Interventions

Chuntao Wu, MD, PhD*,{ddagger},||, Edward L. Hannan, PhD, FACC*,{ddagger},||, Gary Walford, MD, FACC,{dagger}, John A. Ambrose, MD, FACC{ddagger},||, David R. Holmes, Jr, MD, FACC§,{ddagger},||, Spencer B. King, III, MD, FACC||,{ddagger}, Luther T. Clark, MD, FACC,{ddagger},||, Stanley Katz, MD, FACC#, Samin Sharma, MD, FACC** and Robert H. Jones, MD, FACC{dagger}{dagger},{ddagger},||,*

* University at Albany, State University of New York, Albany, New YorkUSA
{dagger} St. Joseph's Hospital, Syracuse, New York USA
{ddagger} St. Vincent's Hospital and Medical Center, New York, New York USA
§ Mayo Clinic, Rochester, Minnesota USA
|| Fuqua Heart Center/Piedmont Hospital, Atlanta, Georgia USA
University Hospital of Brooklyn, Brooklyn, New York USA
# North Shore-LIJ Health System, Manhasset, New York USA
** Mt. Sinai Medical Center, New York, New York USA
{dagger}{dagger} Duke University Medical Center, Durham, North Carolina USA

Manuscript received August 25, 2005; revised manuscript received September 16, 2005, accepted September 20, 2005.

* Reprint requests and correspondence: Dr. Robert H. Jones, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715 (Email: jones060{at}mc.duke.edu).

OBJECTIVES: Our purpose was to develop a risk score to predict in-hospital mortality for percutaneous coronary intervention (PCI) using a statewide population-based PCI registry.

BACKGROUND: Risk scores predicting adverse outcomes after PCI have been developed from a single or a small group of hospitals, and their abilities to be generalized to other patient populations might be affected.

METHODS: A logistic regression model was developed to predict in-hospital mortality for PCI using data from 46,090 procedures performed in 41 hospitals in the New York State Percutaneous Coronary Intervention Reporting System in 2002. A risk score was derived from this model and was validated using 2003 data from New York.

RESULTS: The risk score included nine significant risk factors (age, gender, hemodynamic state, ejection fraction, pre-procedural myocardial infarction, peripheral arterial disease, congestive heart disease, renal failure, and left main disease) that were consistent with other reports. The point values for risk factors range from 1 to 9, and the total risk score ranges from 0 to 40. The observed and recalibrated predicted risks in 2003 were highly correlated for all PCI patients as well as for those in the higher-risk subgroup who suffered myocardial infarctions within 24 h before the procedure. The total risk score for mortality is strongly associated with complication rates and length of stay in the 2003 PCI data.

CONCLUSIONS: The risk score accurately predicted in-hospital death for PCI procedures using future New York data. Its performance in other patient populations needs to be further studied.

Abbreviations and Acronyms
  CI = confidence interval
  MI = myocardial infarction
  OR = odds ratio
  PCI = percutaneous coronary artery intervention




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