Risk scores for 30-day mortality after percutaneous coronary intervention: new insights into causes and risk of death
Mandeep Singh1, Ryan J Lennon2, Rajiv Gulati1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Insights
The New York State Risk Score and Mayo Clinic Risk Score offer similar predictions for death after percutaneous coronary interventions (PCI). The highest risk of mortality occurs within the first two weeks post-PCI, primarily due to cardiac causes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- Percutaneous coronary interventions (PCIs) are common procedures for treating coronary artery disease.
- Accurate risk stratification is crucial for patient management and outcomes after PCI.
- Existing risk scores require validation in diverse patient populations and clinical settings.
Purpose of the Study:
- To evaluate the causes and mortality risk following PCIs.
- To compare the predictive performance of the New York State Risk Score (NYSRS) against the Mayo Clinic Risk Score (MCRS).
- To validate the NYSRS using recalibrated probabilities in a separate patient cohort.
Main Methods:
- A retrospective analysis of 4898 patients undergoing PCI at Mayo Clinic between 2007 and 2010.
- In-hospital and 30-day mortality rates were assessed.
- Receiver operating characteristic (ROC) curves were used to compare the discriminatory power of NYSRS and MCRS.
Main Results:
- Overall in-hospital mortality was 1.9% and 30-day post-discharge mortality was 0.7%.
- Both NYSRS and MCRS demonstrated excellent discrimination (Area Under Curve >0.88).
- The highest risk of death occurred within the first 3 days post-PCI, with cardiac causes predominating, especially within the first week.
Conclusions:
- The discriminatory performance of NYSRS and MCRS for predicting mortality after PCI is comparable.
- The risk of death is most significant in the initial two weeks following PCI.
- Cardiac events, particularly myocardial infarction, are the leading cause of death in the early post-PCI period.
Objective:
To determine the causes and risk of death after percutaneous coronary interventions (PCIs) and to compare the discriminatory ability of the New York State Risk Score (NYSRS) with the Mayo Clinic Risk Score (MCRS).
Patients And Methods:
We studied in-hospital and 30-day mortality after PCI in 4898 patients treated at Mayo Clinic in Rochester, Minnesota, from January 1, 2007, through December 31, 2010, to validate the NYSRS equation with recalibrated predicted probabilities of death.
Results:
Of the 4898 patients studied, 93 (1.9%) died during the index hospitalization, and 36 (0.7%) died within 30 days after discharge. For the in-hospital and 30-day mortality, respectively, the area under the receiver operating characteristic curve was 0.92 and 0.88 for the NYSRS and 0.93 and 0.90 for the MCRS, indicating excellent discrimination. The NYSRS model underpredicted event rates when applied in Mayo Clinic data (2.6% observed [127 of 4898 patients] vs 2.3% predicted [114 of 4898 patients]), even after recalibration. The instantaneous hazard over time revealed the highest risk of death in the first 3 days after PCI (daily probability, >0.2%), declined to 0.1% until about day 12, and then decreased below 0.1%. Cardiac causes (mainly myocardial infarction) dominated in the first week (83 of 85 deaths [97.6%]) and then decreased to 59.5% (25 of 42 deaths) between 8 and 30 days after PCI.
Conclusion:
The discriminatory ability of the NYSRS and the MCRS for in-hospital and 30-day mortality after PCI is roughly interchangeable. The risk of death is highest during the first 2 weeks and is dominated by cardiac causes of death.
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