title: Comorbid conditions and outcomes after percutaneous coronary intervention.
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).
  
  
  METHODS
  Retrospective chart review
  
  
  METHODS
  Academic medical centre.
  
  
  METHODS
  7659 patients who had 9032 PCIs.
  
  
  METHODS
  PCI performed at Mayo Clinic between 1 January 1999 and 30 June 2004.
  
  
  METHODS
  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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. singh.mandeep@mayo.edu
authors.forename: M
authors.initials: M
authors.lastname: Singh
authors.forename: C S
authors.initials: CS
authors.lastname: Rihal
authors.forename: V L
authors.initials: VL
authors.lastname: Roger
authors.forename: R J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: J
authors.initials: J
authors.lastname: Spertus
authors.forename: A
authors.initials: A
authors.lastname: Jahangir
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy; D003930:Diabetic Retinopathy / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D051437:Renal Insufficiency / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome