EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology | 2019
Derivation and External Validation of a Novel Risk Score for Prediction of 30-Day Mortality After Percutaneous Coronary Intervention.
Abstract
AIMS\nEarly mortality after percutaneous coronary intervention (PCI) is relatively rare. Current risk prediction models for this event are outdated. We sought to derive a 30-day mortality risk score after PCI.\n\n\nMETHODS AND RESULTS\nThe score was derived from a pooled database of 21 randomized clinical trials using a logistic regression model incorporating clinical and angiographic variables. The score was validated in a separate unrestricted study population, the Assessment of Dual AntiPlatelet Therapy with Drug Eluting Stents (ADAPT-DES) registry. Of 32,882 eligible patients, 75% had data for all 19 variables used for score derivation. The independent predictors of 30-day mortality were age, presentation with ACS, diabetes mellitus, use of first-generation drug-eluting stents, left main or left anterior descending artery lesion, prior myocardial infarction (MI), and suboptimal flow in the artery before or after PCI. The median [interquartile range] score in the derivation cohort was 5 [3,6] and overall mortality was 0.49%, ranging from 0.08% to 1.64% with scores of 0-16. The 30-day mortality rate was approximately 10-fold higher in patients with a score at or above versus below the median of 5 (0.86% versus 0.08%, P<0.0001). Discrimination in both cohorts was very good (C statistic = 0.848 and 0.828, respectively), and calibration was satisfactory.\n\n\nCONCLUSIONS\nA novel risk score incorporating 8 readily available clinical and angiographic variables had high discrimination for 30-day death after PCI across a wide range of clinical scenarios.