Validation of the Mayo Clinic Percutaneous Coronary Intervention Risk Prediction Score in Patients With Acute
Antonio Landi1,2, Andrea Zito1,3, Mandeep Singh4
1Cardiocentro Ticino Institute Ente Ospedaliero Cantonale (EOC) Lugano Switzerland.
Insights
The Mayo Clinic integer risk score effectively predicts in-hospital adverse events like mortality and bleeding in acute coronary syndrome patients undergoing percutaneous coronary intervention. This validation confirms its value in identifying high-risk individuals for targeted interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Prediction
Background:
- A novel risk score for percutaneous coronary intervention (PCI) adverse events requires external validation in acute coronary syndrome (ACS) patients.
- The Mayo Clinic integer risk score was developed but not yet validated in a large ACS cohort.
Purpose of the Study:
- To externally validate the Mayo Clinic integer risk score in patients with ACS undergoing PCI.
- To assess the predictive performance of two models (A and B) of the risk score for key in-hospital adverse events.
Main Methods:
- Utilized data from 6724 patients in the MATRIX trial undergoing PCI.
- Evaluated two versions of the risk score (model A: 23 variables; model B: 18 preprocedural variables).
- Assessed receiver-operator characteristics for in-hospital mortality, bleeding, contrast-associated acute kidney injury, and stroke.
Main Results:
- Both models demonstrated good discrimination for in-hospital mortality (AUC ~0.88).
- Model A showed better discrimination for bleeding (AUC 0.66) and contrast-associated acute kidney injury (AUC 0.70) compared to Model B.
- Risk score categories correlated with increased 1-year mortality and bleeding risk.
Conclusions:
- The Mayo Clinic integer risk score is a valuable tool for identifying ACS patients at incremental risk of adverse events post-PCI.
- The score aids in stratifying risk for mortality, bleeding, contrast-associated acute kidney injury, and stroke.
- Facilitates mitigation strategies for modifiable risk factors in high-risk ACS patients.
Background:
A contemporary, comprehensive risk score for the prediction of in-hospital fatal and nonfatal adverse events after percutaneous coronary intervention has been recently developed, albeit its external validation in patients with acute coronary syndrome is lacking. The objective of this study is to validate the Mayo Clinic integer risk score in a large cohort of patients with acute coronary syndrome undergoing percutaneous coronary intervention from the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial.
Methods:
The risk score is composed of a common set of 23 clinical and procedural variables (model A) and 18 preprocedural variables (model B). The primary objective was to appraise the receiver-operator characteristics of both models for in-hospital mortality, bleeding, contrast-associated acute kidney injury, and stroke. The impact of risk score categories on 1-year outcomes was also investigated.
Results:
Among the 6724 patients undergoing percutaneous coronary intervention in the MATRIX trial, the receiver-operator characteristics-area under the curves for in-hospital mortality, bleeding, contrast-associated acute kidney injury, and stroke were 0.88 (95% CI, 0.85-0.91), 0.66 (95% CI, 0.63-0.69), 0.70 (95% CI, 0.67-0.72), and 0.65 (95% CI, 0.52-0.78) for model A and 0.88 (95% CI, 0.84-0.92), 0.63 (95% CI, 0.60-0.66), 0.66 (95% CI, 0.63-0.69), and 0.65 (95% CI, 0.52-0.78) for model B, respectively. Mortality (model A), bleeding, and stroke risks were well calibrated, whereas mortality (model B) and contrast-associated acute kidney injury risk were underestimated. There was a gradual risk increase for 1-year mortality and bleeding as a function of the risk score tertile using both models.
Conclusions:
The risk score identifies patients with acute coronary syndrome at incremental risk of in-hospital mortality, bleeding, contrast-associated acute kidney injury, and stroke, representing a valuable tool for mitigation of modifiable risk factors.
Registration:
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01433627.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management