title: In-hospital mortality risk prediction after percutaneous coronary interventions: Validating and updating the Toronto score in Brazil.
abstract: OBJECTIVE
  We aimed to assess the accuracy of the simple, contemporary and well-designed Toronto PCI mortality risk score in ICP-BR registry, the first Brazilian PCI multicenter registry with follow-up information.
  
  
  BACKGROUND
  Estimating percutaneous coronary intervention (PCI) mortality risk by a clinical prediction model is imperative to help physicians, patients and family members make informed clinical decisions and optimize participation in the consent process, reducing anxiety and improving quality of care. At a healthcare system level, risk prediction scores are essential to measure and benchmark performance.
  
  
  METHODS
  Between 2009 and 2013, a cohort of 4,806 patients from the ICP-BR registry, treated with PCI in eight tertiary referral medical centers, was included in the analysis. This population was compared to 10,694 patients of the derivation dataset from the Toronto study. To assess predictive performance, an update of the model was performed by three different methods, which were compared by discrimination, calculating the area under the receiver operating characteristic curve (AUC), and by calibration, assessed through Hosmer-Lemeshow (H-L) test and graphical analysis.
  
  
  RESULTS
  Death occurred in 2.6% of patients in the ICP-BR registry and in 1.3% in the Toronto cohort. The median age was 64 and 63 years, 23.8 and 32.8% were female, 28.6 and 32.3% were diabetics, respectively. Through recalibration of intercept and slope (AUC = 0.8790; H-L P value = 0.3132), we achieved a well-calibrated and well-discriminative model.
  
  
  CONCLUSIONS
  After updating to our dataset, we demonstrated that the Toronto PCI in-hospital mortality risk score performed well in Brazilian hospitals.
authors.affiliation: Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Lucas
authors.initials: L
authors.lastname: Lodi-Junqueira
authors.affiliation: Department of Statistics, Institute of Exact Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: José L P
authors.initials: JL
authors.lastname: da Silva
authors.affiliation: Department of Internal Medicine, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Lorena R
authors.initials: LR
authors.lastname: Ferreira
authors.affiliation: Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Humberto L
authors.initials: HL
authors.lastname: Gonçalves
authors.affiliation: Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Guilherme R S
authors.initials: GR
authors.lastname: Athayde
authors.affiliation: Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Thalles O
authors.initials: TO
authors.lastname: Gomes
authors.affiliation: Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Júlio C
authors.initials: JC
authors.lastname: Borges
authors.affiliation: Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.|Department of Internal Medicine, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Nascimento
authors.affiliation: Department of Interventional Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Department of Internal Medicine, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Antônio L P
authors.initials: AL
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D001938:Brazil; D002170:Canada; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
keywords: coronary artery disease; epidemiology; health care outcomes; percutaneous coronary intervention; risk stratification; statistical analysis