Clinical Studies
Multivariate prediction of in-hospital mortality after percutaneous coronary interventions in 1994–1996

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Abstract

OBJECTIVES

Using recent data, we sought to identify risk factors associated with in-hospital mortality among patients undergoing percutaneous coronary interventions.

BACKGROUND

The ability to accurately predict the risk of an adverse outcome is important in clinical decision making and for risk adjustment when assessing quality of care. Most clinical prediction rules for percutaneous coronary intervention (PCI) were developed using data collected before the broader use of new interventional devices.

METHODS

Data were collected on 15,331 consecutive hospital admissions by six clinical centers. Logistic regression analysis was used to predict the risk of in-hospital mortality.

RESULTS

Variables associated with an increased risk of in-hospital mortality included older age, congestive heart failure, peripheral or cerebrovascular disease, increased creatinine levels, lowered ejection fraction, treatment of cardiogenic shock, treatment of an acute myocardial infarction, urgent priority, emergent priority, preprocedure insertion of an intraaortic balloon pump and PCI of a type C lesion. The receiver operating characteristic area for the predicted probability of death was 0.88, indicating a good ability to discriminate. The rule was well calibrated, predicting accurately at all levels of risk. Bootstrapping demonstrated that the estimate was stable and performed well among different patient subsets.

CONCLUSIONS

In the current era of interventional cardiology, accurate calculation of the risk of in-hospital mortality after a percutaneous coronary intervention is feasible and may be useful for patient counseling and for quality improvement purposes.

Abbreviations

CABG
coronary artery bypass graft surgery
CI
confidence interval
COPD
chronic obstructive pulmonary disease
EF
ejection fraction
IABP
intraaortic balloon pump
LVEDP
left ventricular end-diastolic pressure
MI
myocardial infarction
OR
odds ratio
PCI
percutaneous coronary intervention
PTCA
percutaneous transluminal coronary angioplasty
PVD
peripheral vascular disease
ROC
receiver operating characteristic
χ2LR
likelihood ratio chi-square test

Cited by (0)

Funding for this study was provided by the participating institutions of the Northern New England Cardiovascular Disease Study Group.

‡‡

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