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Multicenter Study
. 2017 Nov 21;136(21):2009-2019.
doi: 10.1161/CIRCULATIONAHA.117.027714. Epub 2017 Sep 7.

Modeling Major Adverse Outcomes of Pediatric and Adult Patients With Congenital Heart Disease Undergoing Cardiac Catheterization: Observations From the NCDR IMPACT Registry (National Cardiovascular Data Registry Improving Pediatric and Adult Congenital Treatment)

Natalie Jayaram  1 , John A Spertus  2 , Kevin F Kennedy  2 , Robert Vincent  3 , Gerard R Martin  4 , Jeptha P Curtis  5 , David Nykanen  6 , Phillip M Moore  7 , Lisa Bergersen  8
Affiliations
Multicenter Study

Modeling Major Adverse Outcomes of Pediatric and Adult Patients With Congenital Heart Disease Undergoing Cardiac Catheterization: Observations From the NCDR IMPACT Registry (National Cardiovascular Data Registry Improving Pediatric and Adult Congenital Treatment)

Natalie Jayaram et al. Circulation. .

Abstract

Background: Risk standardization for adverse events after congenital cardiac catheterization is needed to equitably compare patient outcomes among different hospitals as a foundation for quality improvement. The goal of this project was to develop a risk-standardization methodology to adjust for patient characteristics when comparing major adverse outcomes in the NCDR's (National Cardiovascular Data Registry) IMPACT Registry (Improving Pediatric and Adult Congenital Treatment).

Methods: Between January 2011 and March 2014, 39 725 consecutive patients within IMPACT undergoing cardiac catheterization were identified. Given the heterogeneity of interventional procedures for congenital heart disease, new procedure-type risk categories were derived with empirical data and expert opinion, as were markers of hemodynamic vulnerability. A multivariable hierarchical logistic regression model to identify patient and procedural characteristics predictive of a major adverse event or death after cardiac catheterization was derived in 70% of the cohort and validated in the remaining 30%.

Results: The rate of major adverse event or death was 7.1% and 7.2% in the derivation and validation cohorts, respectively. Six procedure-type risk categories and 6 independent indicators of hemodynamic vulnerability were identified. The final risk adjustment model included procedure-type risk category, number of hemodynamic vulnerability indicators, renal insufficiency, single-ventricle physiology, and coagulation disorder. The model had good discrimination, with a C-statistic of 0.76 and 0.75 in the derivation and validation cohorts, respectively. Model calibration in the validation cohort was excellent, with a slope of 0.97 (standard error, 0.04; P value [for difference from 1] =0.53) and an intercept of 0.007 (standard error, 0.12; P value [for difference from 0] =0.95).

Conclusions: The creation of a validated risk-standardization model for adverse outcomes after congenital cardiac catheterization can support reporting of risk-adjusted outcomes in the IMPACT Registry as a foundation for quality improvement.

Keywords: catheterization; congenital heart disease; outcomes; risk adjustment.

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Figures

Figure 1
Figure 1. Unadjusted and fully-adjusted rates of major adverse event rates across the IMPACT sites
Figure 2
Figure 2. Calibration of the Final Reduced Model in the Validation Cohort
The model showed excellent calibration, with slope of 0.97.
See this image and copyright information in PMC

Comment in

References

    1. Moore JW, Vincent RN, Beekman RH, 3rd, Benson L, Bergersen L, Holzer R, Jayaram N, Jenkins K, Li Y, Ringel R, Rome J, Martin GR, Committee NIS Procedural results and safety of common interventional procedures in congenital heart disease: initial report from the National Cardiovascular Data Registry. Journal of the American College of Cardiology. 2014;64:2439–51. - PubMed
    1. Bergersen L, Gauvreau K, Foerster SR, Marshall AC, McElhinney DB, Beekman RH, 3rd, Hirsch R, Kreutzer J, Balzer D, Vincent J, Hellenbrand WE, Holzer R, Cheatham JP, Moore JW, Burch G, Armsby L, Lock JE, Jenkins KJ. Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM) JACC Cardiovascular interventions. 2011;4:1037–46. - PubMed
    1. Jayaram N, Beekman RH, 3rd, Benson L, Holzer R, Jenkins K, Kennedy KF, Martin GR, Moore JW, Ringel R, Rome J, Spertus JA, Vincent R, Bergersen L. Adjusting for Risk Associated With Pediatric and Congenital Cardiac Catheterization: A Report From the NCDR IMPACT Registry. Circulation. 2015;132:1863–70. - PMC - PubMed
    1. Jenkins KJ, Beekman RH, Iii, Bergersen LJ, Everett AD, Forbes TJ, Franklin RC, Klitzner TS, Krogman ON, Martin GR, Webb CL. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease--the perspective of cardiology. Cardiology in the young. 2008;18(Suppl 2):116–23. - PubMed
    1. Martin GR, Beekman RH, Ing FF, Jenkins KJ, McKay CR, Moore JW, Ringel RE, Rome JJ, Ruiz CE, Vincent RN. The IMPACT registry: IMproving Pediatric and Adult Congenital Treatments. Seminars in thoracic and cardiovascular surgery Pediatric cardiac surgery annual. 2010;13:20–5. - PubMed

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