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Interventional cardiology
Comorbid conditions and outcomes after percutaneous coronary intervention
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  1. M Singh1,
  2. C S Rihal1,
  3. V L Roger1,
  4. R J Lennon2,
  5. J Spertus3,
  6. A Jahangir1,
  7. D R Holmes Jr1
  1. 1
    Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2
    Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
  3. 3
    Cardiovascular Education and Outcome Research, Mid America Heart Institute, Kansas City, Missouri, USA
  1. Dr M Singh, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; singh.mandeep{at}mayo.edu

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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Footnotes

  • Competing interests: None declared.

  • Ethics approval: The Mayo Clinic Institutional Review Board approved the study

  • See Editorial, p 1366

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