title: External validation of a percutaneous coronary intervention mortality prediction model in patients with acute coronary syndromes.
abstract: BACKGROUND
  The recently published Michigan outcome prediction model (MM) for inhospital mortality was developed and validated on a series of consecutive patients undergoing percutaneous coronary intervention (PCI). Our purpose was to externally validate the performance of the MM in 2 separate cohorts of patients with acute coronary syndrome (ACS) undergoing PCI in Canada.
  
  
  METHODS
  A validation of the MM and development of an extended MM were performed on data describing 10,050 patients from the APPROACH prospective cohort study between January 1995 and December 2000. Performance of both models was assessed on an external data set of 3259 PCI cases from the British Columbia Cardiac Registries. Only patients with a diagnosis of ACS were included in the study.
  
  
  RESULTS
  The original MM predicted death rates ranging from 0.1% to 60.6%, but lacked accuracy to predict inhospital mortality as severity increased. The extended MM predicted death rates more widely from 0.0% to a high of 91.0% with better accuracy to predict inhospital death in patients with ACS undergoing PCI. The areas under the receiver operating characteristic curve for the MM and the extended MM on the external validation data set were 0.93 and 0.95, respectively.
  
  
  CONCLUSIONS
  The MM predicts death after PCI in patients with ACS and identifies a clear gradient of risk. However, the enhanced MM developed specifically for the subset of patients with ACS demonstrated better prediction and cross-validated performance. These prediction rules can be useful for risk-adjustment analyses and for prognostication for individual patients.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hubacek
authors.forename: P Diane
authors.initials: PD
authors.lastname: Galbraith
authors.forename: Min
authors.initials: M
authors.lastname: Gao
authors.forename: Karin
authors.initials: K
authors.lastname: Humphries
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Graham
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D002170:Canada; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D012372:ROC Curve; D013577:Syndrome
chemical_list: D003404:Creatinine