Predicting vascular complications in percutaneous coronary interventions.
OBJECTIVE
Using a large, current, regional registry of percutaneous coronary interventions (PCI), we identified risk factors for postprocedure vascular complications and developed a scoring system to estimate individual patient risk.


BACKGROUND
A vascular complication (access-site injury requiring treatment or bleeding requiring transfusion) is a potentially avoidable outcome of PCI.


METHODS
Data were collected on 18,137 consecutive patients undergoing PCI in northern New England from January 1997 to December 1999. Multivariate regression was used to identify characteristics associated with vascular complications and to develop a scoring system to predict risk.


RESULTS
The rate of vascular complication was 2.98% (541 cases). Variables associated with increased risk in the multivariate analysis included age >or=70, odds ratio (OR) 2.7, female sex (OR 2.4), body surface area <1.6 m(2) (OR 1.9), history of congestive heart failure (OR 1.4), chronic obstructive pulmonary disease (OR 1.5), renal failure (OR 1.9), lower extremity vascular disease (OR 1.4), bleeding disorder (OR 1.68), emergent priority (OR 2.3), myocardial infarction (OR 1.7), shock (1.86), >or=1 type B2 (OR 1.32) or type C (OR 1.7) lesions, 3-vessel PCI (OR 1.5), use of thienopyridines (OR 1.4) or use of glycoprotein IIb/IIIa receptor inhibitors (OR 1.9). The model performed well in tests for significance, discrimination, and calibration. The scoring system captured 75% of actual vascular complications in its highest quintiles of predicted risk.


CONCLUSIONS
Predicting the risk of post-PCI vascular complications is feasible. This information may be useful for clinical decision-making and institutional efforts at quality improvement.
Piper
Winthrop D
WD
Clinical Research Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. w.piper@dartmouth.edu
Malenka
David J
DJ
Ryan
Thomas J
TJ
Shubrooks
Samuel J
SJ
O'Connor
Gerald T
GT
Robb
John F
JF
Farrell
Karen L
KL
Corliss
Mary S
MS
Hearne
Michael J
MJ
Kellett
Mirle A
MA
Watkins
Matthew W
MW
Bradley
William A
WA
Hettleman
Bruce D
BD
Silver
Theodore M
TM
McGrath
Paul D
PD
O'Mears
John R
JR
Wennberg
David E
DE
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D014652:Vascular Diseases / Q000209:etiology*