Procedural Risk in Congenital Cardiac Catheterization (PREDIC³T).

Area of Science:

• Cardiology
• Pediatric Cardiology
• Medical Informatics

Background:

• Evolving interventional procedures in congenital cardiology necessitate updated patient risk assessment tools.
• Current risk stratification models may not fully capture the complexities of modern congenital cardiac catheterization.
• This study aimed to develop novel risk classification systems for hemodynamic and procedural risk in pediatric cardiac catheterization.

Observation:

• Data from 23,119 cases in the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry (2014-2017) were analyzed.
• High-severity adverse events occurred in 5.2% of cases, with a significant proportion involving patients under 1 year of age.
• Thirty-four unique procedure types were identified and stratified into six distinct risk categories.

Findings:

• Procedure-type risk categories were independently associated with high-severity adverse events (ORs ranging from 0.46 to 5.25, P≤0.005).
• A novel hemodynamic vulnerability score, derived from six indicator variables, also independently predicted adverse events (ORs ranging from 1.00 to 2.03, P≤0.006).
• Both the case-type risk categories and the hemodynamic vulnerability score demonstrated significant predictive power for patient risk.

Implications:

• The developed case-type risk categories offer a contemporary metric for procedural risk in congenital cardiac catheterization.
• The hemodynamic vulnerability score provides a novel, weighted assessment of patient-specific risk factors.
• These tools are expected to enhance the understanding and management of patient and procedural outcomes in pediatric cardiology.