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Percutaneous coronary intervention and 30-day mortality: the British Columbia PCI risk score
Jaap N Hamburger1, Simon J Walsh, Rohit Khurana
1Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. jaap.hamburger@gmail.com
Insights
A new risk calculator, the BC-PCI risk score, predicts 30-day mortality after percutaneous coronary intervention (PCI). This validated tool aids management decisions for patients undergoing PCI, offering improved risk assessment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Informatics
Background:
- 30-day mortality predictors are crucial for cardiac surgical patient management.
- A similar risk score is needed for percutaneous coronary intervention (PCI) due to patient overlap between surgical and interventional procedures.
- Existing risk stratification for PCI patients requires enhancement.
Purpose of the Study:
- To develop and validate a risk calculator for predicting 30-day mortality following PCI.
- To identify key predictors of 30-day mortality in a large PCI patient cohort.
- To create a user-friendly tool for clinical decision support.
Main Methods:
- Utilized the population-based British Columbia Cardiac Registry (BCCR) data.
- Identified risk factors for mortality through univariate analysis.
- Developed a multivariable logistic regression model using a training set (2000-2004) and validated it on a separate set (2005).
Main Results:
- A total of 32,899 PCI patients were analyzed, with a 30-day mortality rate of 1.5%.
- The final risk score included objective, pre-PCI variables.
- The model demonstrated high predictive accuracy, with an Area Under the ROC curve of 90.2% (training) and 91.1% (validation).
Conclusions:
- A robust, validated model for 30-day mortality after PCI was developed.
- The BC-PCI risk score calculator is now available online for clinical use.
- This tool provides a reliable method for assessing mortality risk in PCI patients.
Objectives:
To construct a calculator to assess the risk of 30-day mortality following PCI.
Background:
Predictors of 30-day mortality are commonly used to aid management decisions for cardiac surgical patients. There is a need for an equivalent risk-score for 30-day mortality for percutaneous coronary intervention (PCI) as many patients are suitable for both procedures.
Methods:
The British Columbia Cardiac Registry (BCCR) is a population-based registry that collects information on all PCI procedures performed in British Columbia (BC). We used data from the BCCR to identify risk factors for mortality in PCI patients and construct a calculator that predicts 30-day mortality.
Results:
Patients (total n = 32,899) were divided into a training set (n = 26,350, PCI between 2000 and 2004) and validation set (n = 6,549, PCI in 2005). Univariate predictors of mortality were identified. Multivariable logistic regression analysis was performed on the training set to develop a statistical model for prediction of 30-day mortality. This model was tested in the validation set. Variables that were objective and available before PCI were included in the final risk score calculator. The 30-day mortality for the overall population was 1.5% (n = 500). Area under the ROC curve was 90.2% for the training set and 91.1% for the validation set indicating that the model also performed well in this group.
Conclusions:
We describe a large, contemporary cohort of patients undergoing PCI with complete follow-up for 30-day mortality. A robust, validated model of 30-day mortality after PCI was used to construct a risk calculator, the BC-PCI risk score, which can be accessed at www.bcpci.org.
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