Tree-structured risk stratification of in-hospital mortality after percutaneous coronary intervention for acute myocardial infarction: A report from the New York State percutaneous coronary intervention database

Abstract

BACKGROUND: Previous risk scores have shown excellent performance. However, the need for real-time risk score computation makes their implementation in an emergent situation challenging. A more simplified approach can provide practitioners with a practical bedside risk stratification tool.

Contemporary Mortality Risk Prediction for Percutaneous Coronary Intervention

“…However, many of these were developed using data that predates the generalized use of stents and/or contemporary adjuvant antithrombotic therapy (5-13). Other models have been developed from select referral centers or regional populations and may not be as generalizable across the nation (7-9,11,14-19). Still, other models were developed using databases that included only elderly patients, or used administrative data which lacked the clinical details necessary to capture the important clinical and angiographic risks factors associated with peri-procedural mortality (9,20,21).…”

“…Yet many have become outdated and do not reflect contemporary care or outcomes (5-13). Other risk models were developed on select populations and may not be generalizable (7-9,11,14-19). Additionally, many models failed to consider angiographic features that are associated with procedural risk (9,20,21).…”

“…Other risk models were developed on select populations and may not be generalizable (7-9,11,14-19). Additionally, many models failed to consider angiographic features that are associated with procedural risk (9,20,21). The National Cardiovascular Data Registry (NCDR) for Catheterization Percutaneous Coronary Intervention (CathPCI) provides the ideal infrastructure to derive procedure risk models in a national representative contemporary US sample.…”

Development and Validation of a Risk Scoring Model to Predict Net Adverse Cardiovascular Outcomes after Primary Percutaneous Coronary Intervention in Patients Pretreated with 600 mg Clopidogrel: Rationale and Design of the RISK‐PCI Study

“…Catheter‐based reperfusion offers an additional opportunity to include angiographic and left ventricular function data, which are known to be of prognostic significance, into risk models 19 . However, only a few risk scores were developed in populations treated exclusively by primary PCI, mostly without taking into account the procedural variables and/or left ventricular ejection fraction, which significantly affects the outcome of these patients 20–22 …”

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

“…The National Cardiovascular Data Registry (NCDR) score was determined in a large cohort and identified increased unadjusted in-hospital mortality for patients older than 70 years as compared to patients ≤70 years (2.25% vs. 0.76%) [43••]. Several risk scores, including the NCDR score, the Toronto PCI mortality score [45], the New York State percutaneous database [46], and the Mayo Clinic Risk Score [47], consistently report an increased mortality risk for patients older than 70 years and more importantly for patients older than 80 years. Peripheral artery disease, renal failure, and cerebrovascular disease are frequently encountered comorbidities in patients of advanced age and have additional predictive value in these scores.…”