Derivation and external validation of a novel risk score for prediction of 30-day mortality after percutaneous coronary intervention

Sorin J. Brener, Martin B. Leon, Patrick W. Serruys, Pieter C. Smits, Clemens M. Von Birgelen, Roxana Mehran, Ajay J. Kirtane, Bernhard Witzenbichler, Michael J. Rinaldi, D. Christopher Metzger, Ernest L. Mazzaferri, Zixuan Zhang, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Aims: Early mortality after percutaneous coronary intervention (PCI) is relatively rare. Current risk prediction models for this event are outdated. We sought to derive a 30-day mortality risk score after PCI. Methods and results: The score was derived from a pooled database of 21 randomised clinical trials using a logistic regression model incorporating clinical and angiographic variables. The score was validated in a separate unrestricted study population, the Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents (ADAPT-DES) registry. Of 32,882 eligible patients, 75% had data for all 19 variables used for score derivation. The independent predictors of 30-day mortality were age, presentation with ACS, diabetes mellitus, use of first-generation drug-eluting stents, left main or left anterior descending artery lesion, prior myocardial infarction (MI), and suboptimal flow in the artery before or after PCI. The median [interquartile range] score in the derivation cohort was 5 [3, 6] and overall mortality was 0.49%, ranging from 0.08% to 1.64% with scores of 0-16. The 30-day mortality rate was approximately tenfold higher in patients with a score at or above versus below the median of 5 (0.86% versus 0.08%, p<0.0001). Discrimination in both cohorts was very good (C statistic=0.848 and 0.828, respectively), and calibration was satisfactory. Conclusions: A novel risk score incorporating eight readily available clinical and angiographic variables had high discrimination for 30-day death after PCI across a wide range of clinical scenarios.

Original languageEnglish
Pages (from-to)E551-E557
JournalEuroIntervention
Volume15
Issue number6
DOIs
StatePublished - 2019

Keywords

  • Death
  • Drug-eluting stent
  • Risk stratification

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