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. 2008 Nov;94(11):1424-8.
doi: 10.1136/hrt.2007.126649. Epub 2007 Oct 8.

Comorbid conditions and outcomes after percutaneous coronary intervention

M Singh  1 , C S Rihal, V L Roger, R J Lennon, J Spertus, A Jahangir, D R Holmes Jr
Affiliations

Comorbid conditions and outcomes after percutaneous coronary intervention

M Singh et al. Heart. 2008 Nov.

Abstract

Objective: To evaluate whether adding comorbid conditions to a risk model can help predict in-hospital outcome and long-term mortality after percutaneous coronary intervention (PCI).

Design: Retrospective chart review

Setting: Academic medical centre.

Patients: 7659 patients who had 9032 PCIs.

Interventions: PCI performed at Mayo Clinic between 1 January 1999 and 30 June 2004.

Main outcome measures: The Mayo Clinic Risk Score (MCRS) and the coronary artery disease (CAD)-specific index for determination of comorbid conditions in all patients.

Results: The mean (SD) MCRS score was 6.5 (2.9). The CAD-specific index was 0 or 1 in 46%, 2 or 3 in 30% and 4 or higher in 24%. The rate of in-hospital major adverse cardiovascular events (MACE) increased with higher MCRS and CAD-specific index (Cochran-Armitage test, p<0.001 for both models). The c-statistic for the MCRS for in-hospital MACE was 0.78; adding the CAD-specific index did not improve its discriminatory ability for in-hospital MACE (c-statistic = 0.78; likelihood ratio test, p = 0.29). A total of 707 deaths after dismissal occurred after 7253 successful procedures. The c-statistic for all-cause mortality was 0.69 for the MCRS model alone and 0.75 for the MCRS and CAD-specific indices together (likelihood ratio test, p<0.001), indicating significant improvement in the discriminatory ability.

Conclusions: Addition of comorbid conditions to the MCRS adds significant prognostic information for post-dismissal mortality but adds little prognostic information about in-hospital complications after PCI. Such health-status measures should be included in future risk stratification models that predict long-term mortality after PCI.

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Figures

Fig. 1
Fig. 1
Mosaic plot indicating the correlation between Mayo Clinic Risk Score (MCRS) and coronary artery disease (CAD)-specific index. The frequency of PCIs for each cross-tabulation cell is shown within a rectangle that is proportional in size to the frequency.
Fig. 2
Fig. 2
Kaplan-Meier curves estimating survival among patients. A, Patients grouped by Mayo Clinic Risk Score. B, Patients grouped by coronary artery disease (CAD)-specific index of comorbid conditions.
Fig. 2
Fig. 2
Kaplan-Meier curves estimating survival among patients. A, Patients grouped by Mayo Clinic Risk Score. B, Patients grouped by coronary artery disease (CAD)-specific index of comorbid conditions.
See this image and copyright information in PMC

Comment in

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