Original articlesMajor adverse outcomes after percutaneous transluminal coronary angioplasty: a clinical prediction rule
Introduction
Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure that can reopen occluded coronary arteries, but as with most interventions, there is associated risk. Variation in severity of illness before PTCA presents obstacles to accurate, standardized comparison of patient outcomes. Thus, clinical prediction rules that can identify risk factors and accurately stratify patients according to risk of having a major adverse outcome after PTCA, similar to those prediction models widely used in coronary artery bypass surgery [1], may be helpful in improving patient care and outcomes. A number of published studies have attempted to identify risk factors for mortality and/or morbidity after PTCA 2, 3, 4, 5. Risk factors for death or major morbidity after PTCA that have been identified by previous studies include: female gender, advancing age, diabetes mellitus, unstable angina, multivessel disease, presence of a thrombus, lesion length, and certain lesion morphologies such as eccentric, calcified, or nondiscrete lesions 6, 7, 8, 9. However, few published studies to date present tools that can stratify patients according to overall level of risk of having an adverse outcome after PTCA [10]. In this study, we develop and internally validate a clinical model for predicting major adverse outcomes in patients undergoing PTCA, and compare its performance to another published model.
Section snippets
Patient population
Data collection for the study took place from August 1993 to October 1995, at 12 medical centers. All 12 centers were large tertiary care centers and were members of the Academic Medical Center Consortium, which sponsored the study, called the Quality Measurement and Management Initiative (QMMI) Coronary Revascularization Project. Patients enrolled in the study included all patients who underwent a PTCA procedure at any of the 12 participating medical centers. The unit of analysis was the PTCA;
Characteristics of the derivation and validation sets
The QMMI dataset included 14,030 episodes of PTCA, of which 12,133 represented unique patients. Of the 14,030 total episodes, 9,286 were randomly allocated to the derivation set and the remaining 4,744 to the validation set (Table 1). Preprocedure patient characteristics including age, gender, and disease histories were not significantly different across derivation and validation sets (Table 1). In the derivation subset, the PTCA was elective for 61.2% of cases, urgent for 28.7%, and emergent
Discussion
Although several clinical prediction models are currently available for use in patients undergoing coronary artery bypass surgery, some of which have achieved wide clinical use in helping to identify patients at highest risk of dying or suffering a nonfatal major morbidity after surgery, few published studies have attempted to identify risk factors that are independently correlated with adverse outcomes after PTCA. Like coronary bypass surgery, PTCA is a commonly performed procedure that on the
Conclusions
In this study, we developed and internally validated a clinical prediction rule for use in patients undergoing PTCA. The rule is an additive severity score that can estimate a patient's risk of suffering an adverse outcome after PTCA, using data available prior to the procedure, with very good discrimination and reasonable calibration performance. Such tools may allow more accurate quality comparisons across institutions and physicians, help target specific resources to patients according to
Acknowledgements
A list of the members of the Academic Medical Center Consortium Quality Measurement and Management Initiative Working Group appears at the end of this article.
References (23)
- et al.
One-year outcomes of diabetic versus nondiabetic patients with non-Q-wave acute myocardial infarction treated with percutaneous transluminal coronary angioplasty
Am J Cardiol
(1998) - et al.
Development and validation of a simplified predictive index for major complications in contemporary percutaneous transluminal coronary angioplasty practice
J Am Coll Cardiol
(1995) Basic principles of ROC analysis
Semin Nucl Med
(1978)- et al.
Clinical outcome after multivessel coronary stent implantation
Am Heart J
(1999) - et al.
Identification of variables needed to risk adjust outcomes of coronary interventionsevidence-based guidelines for efficient data collection
J Am Coll Cardiol
(1998) - et al.
Prediction rules for major adverse outcomes in coronary bypass surgerya comparison and methodological critique
Med Care
(2000) - et al.
Incidence and consequences of periprocedural occlusionthe 1985–1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry
Circulation
(1990) - et al.
Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty
Circulation
(1988) - et al.
Coronary morphologic and clinical determinants of procedural outcome with antioplasty for multivessel coronary diseaseimplications for patient selection
Circulation
(1990) - et al.
Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplastyfrequency, prediction, clinical course, management, and follow-up
Circulation
(1991)
Results of percutaneous transluminal coronary angioplasty in women1985–1986 National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry
Circulation
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