Comorbid conditions and outcomes after percutaneous coronary intervention.
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.
Singh
M
M
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. singh.mandeep@mayo.edu
Rihal
C S
CS
Roger
V L
VL
Lennon
R J
RJ
Spertus
J
J
Jahangir
A
A
Holmes
D R
DR
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