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Randomized Controlled Trial
. 2012 Mar 27;125(12):1501-10.
doi: 10.1161/CIRCULATIONAHA.111.066969. Epub 2012 Feb 23.

Prediction of long-term mortality after percutaneous coronary intervention in older adults: results from the National Cardiovascular Data Registry

William S Weintraub  1 , Maria V Grau-Sepulveda, Jocelyn M Weiss, Elizabeth R Delong, Eric D Peterson, Sean M O'Brien, Paul Kolm, Lloyd W Klein, Richard E Shaw, Charles McKay, Laura L Ritzenthaler, Jeffrey J Popma, John C Messenger, David M Shahian, Frederick L Grover, John E Mayer, Kirk N Garratt, Issam D Moussa, Fred H Edwards, George D Dangas
Affiliations
Randomized Controlled Trial

Prediction of long-term mortality after percutaneous coronary intervention in older adults: results from the National Cardiovascular Data Registry

William S Weintraub et al. Circulation. .

Abstract

Background: The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention in both patients with ST-segment elevation myocardial infarction and those with more stable coronary disease.

Methods and results: The American College of Cardiology Foundation CathPCI Registry data were linked to the Centers for Medicare and Medicaid Services 100% denominator file by probabilistic matching. Preprocedure demographic and clinical variables from the CathPCI Registry were used to predict the probability of death over 3 years as recorded in the Centers for Medicare and Medicaid Services database. Between 2004 and 2007, 343 466 patients (66%) of 518 195 patients aged ≥65 years undergoing first percutaneous coronary intervention in the CathPCI Registry were successfully linked to Centers for Medicare and Medicaid Services data. This study population was randomly divided into 60% derivation and 40% validation cohorts. Median follow-up was 15 months, with mortality of 3.0% at 30 days and 8.7%, 13.4%, and 18.7% at 1, 2, and 3 years, respectively. Twenty-four characteristics related to demographics, clinical comorbidity, prior history of disease, and indices of disease severity and acuity were identified as being associated with mortality. The C indices in the validation cohorts for patients with and without ST-segment elevation myocardial infarction were 0.79 and 0.78. The model calibrated well across a wide range of predicted probabilities.

Conclusions: On the basis of the large and nationally representative CathPCI Registry, we have developed a model that has excellent discrimination, calibration, and validation to predict survival up to 3 years after percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Selection of the study population from the National Cardiovascular Data Registry CathPCI database.
Figure 2
Figure 2
Predicted and observed mortality at 1 year in patients with ST elevation MI (STEMI) and without ST elevation myocardial infarction (Without STEMI).
Figure 3
Figure 3
Predicted and observed mortality over 3 years in patients with ST elevation MI (STEMI) and without ST elevation myocardial infarction (Without STEMI).
Figure 4
Figure 4
Predicted and observed mortality for subgroups over 3 years in patients with ST elevation MI (STEMI).
Figure 5
Figure 5
Predicted and observed mortality for subgroups over 3 years in patients without ST elevation myocardial infarction (Without STEMI).
See this image and copyright information in PMC

Comment in

References

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