Article Text

PDF
Multivariate prediction of major adverse cardiac events after 9914 percutaneous coronary interventions in the north west of England
  1. A D Grayson1,
  2. R K Moore1,
  3. M Jackson1,
  4. S Rathore1,
  5. S Sastry2,
  6. T P Gray3,
  7. I Schofield4,
  8. A Chauhan2,
  9. F F Ordoubadi3,
  10. B Prendergast4,
  11. R H Stables1,
  12. on behalf of the North West Quality Improvement Programme in Cardiac Interventions (NWQIP)
  1. 1The Cardiothoracic Centre, Liverpool, UK
  2. 2Blackpool Victoria Hospital, Blackpool, UK
  3. 3Manchester Royal Infirmary, Manchester, UK
  4. 4South Manchester University Hospital, Manchester, UK
  1. Correspondence to:
    MrAntony D Grayson
    Clinical Governance Department, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK; tony.grayson{at}ctc.nhs.uk

Abstract

Objective: To develop a multivariate prediction model for major adverse cardiac events (MACE) after percutaneous coronary interventions (PCIs) by using the North West Quality Improvement Programme in Cardiac Interventions (NWQIP) PCI Registry.

Setting: All NHS centres undertaking adult PCIs in north west England.

Methods: Retrospective analysis of prospectively collected data on 9914 consecutive patients undergoing adult PCI between 1 August 2001 and 31 December 2003. A multivariate logistic regression analysis was undertaken, with the forward stepwise technique, to identify independent risk factors for MACE. The area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness of fit statistic were calculated to assess the performance and calibration of the model, respectively. The statistical model was internally validated by using the technique of bootstrap resampling.

Main outcome measures: MACE, which were in-hospital mortality, Q wave myocardial infarction, emergency coronary artery bypass graft surgery, and cerebrovascular accidents.

Results: Independent variables identified with an increased risk of developing MACE were advanced age, female sex, cerebrovascular disease, cardiogenic shock, priority, and treatment of the left main stem or graft lesions during PCI. The ROC curve for the predicted probability of MACE was 0.76, indicating a good discrimination power. The prediction equation was well calibrated, predicting well at all levels of risk. Bootstrapping showed that estimates were stable.

Conclusions: A contemporaneous multivariate prediction model for MACE after PCI was developed. The NWQIP tool allows calculation of the risk of MACE permitting meaningful risk adjusted comparisons of performance between hospitals and operators.

  • AHA, American Heart Association
  • CABG, coronary artery bypass grafting
  • CCAD, Central Cardiac Audit Database
  • MACE, major adverse cardiac events
  • MI, myocardial infarction
  • NHS, National Health Service
  • NWQIP, North West Quality Improvement Programme in Cardiac Interventions
  • NYHA, New York Heart Association
  • PCI, percutaneous coronary intervention
  • ROC, receiver operating characteristic
  • major adverse cardiac events
  • percutaneous coronary interventions
  • risk prediction

Statistics from Altmetric.com

Footnotes

  • Published Online First 13 September 2005

  • Contributorship: MJ had the idea of the study. ADG was responsible for the study design and analysis. All authors contributed to preparation of the manuscript. RHS will act as guarantor for the study.

  • Funding: Funding for the NWQIP collaboration has been received from all primary care trusts in the north west of England. All authors were independent from the funding.

  • Conflict of interest: None declared.

  • Ethical approval for the NWQIP was obtained from the North West Multi Research Ethics Committee.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.