- 作者：Stephen G. Ellis ; MD ; elliss@ccf.org ; Mehdi H. Shishehbor ; DO ; MPH ; Samir R. Kapadia ; MD ; A. Michael Lincoff ; MD ; Ravi Nair ; MD ; Patrick L. Whitlow ; MD ; Christopher T. Bajzer ; MD ; Leslie L. Cho ; MD ; E. Murat Tuzcu ; MD ; Russell Raymond ; DO ; Patrick Vargo ; BS ; Rebecca Cunningham ; RN ; Sandra J. Dushman-Ellis ; MPH
- 关键词：Aldrete score ; percutaneous coronary intervention ; risk adjustment
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2011
- 出版时间：April 2011
- 年：2011
- 卷：4
- 期：4
- 页码：442-448
- 全文大小：727 K
Objectives
This study sought to improve methodology for predicting post¨Cpercutaneous coronary intervention (PCI) mortality.Background
Recently, an increased proportion of post-PCI deaths caused by noncardiac causes has been suggested, often in rapidly triaged patients resuscitated from sudden cardiac death or presenting with cardiogenic shock. Older risk adjustment algorithms may not adequately reflect these issues.
Methods
Consecutive patients undergoing PCI from 2000 to 2009 were randomly divided into training (n = 8,966) and validation (n = 8,891) cohorts. The 2010 ACC-NCDR (American College of Cardiology¨CNational Cardiovascular Data Registry) mortality algorithm was applied to the training cohort and its highest risk decile, separately. Variables describing general and neurological status at admission were then tested for their additional predictive capability and new algorithms developed. These were tested in the validation cohort, using receiver-operator characteristic curve, Hosmer-Lemeshow, and reclassification measures as principal outcome measures.
Results
In-hospital mortality was 1.0 % , of which 52.2 % had noncardiac causes or major contributions. Baseline model C-statistics for the total and upper decile training cohorts were 0.904 and 0.830. The Aldrete score (addressing consciousness, respiration, skin color, muscle function, and circulation) and neurology scores added incremental information, resulting in improved validation cohort C-statistics (entire group: 0.883 to 0.914, p < 0.001; high-risk decile: 0.829 to 0.874, p < 0.001). Reclassification of the ACC-NCDR <90th and ?0th risk percentiles by the new score yielded improved mortality prediction (p < 0.001 and p = 0.033, respectively).
Conclusions
Half of in-hospital deaths in this series were of noncardiac causation. Prediction of in-hospital mortality after PCI can be considerably improved over conventional models by the inclusion of variables describing general and neurological status.