Klein et al developed a model for predicting mortality in an octogenarian undergoing percutaneous cutaneous intervention (PCI). This can help to determine the level of risk for the patient. The study was done using the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR).
Patient selection: patients 80 to 90 years of age undergoing PCI
Parameters:
(1) age of the patient in years
(2) left ventricular ejection fraction
(3) acute myocardial infarction
(4) history of a prior PCI
(5) renal failure
(6) COPD (chronic obstructive pulmonary disease)
(7) peripheral vascular disease (PVD)
|
Parameter |
Finding |
Points |
|
age in years |
80 |
0 |
|
|
82 |
2 |
|
|
84 |
3 |
|
|
86 |
5 |
|
|
88 |
6 |
|
|
89 |
8 |
|
LV ejection fraction |
20 |
36 |
|
|
30 |
27 |
|
|
40 |
18 |
|
|
50 |
9 |
|
|
60 |
0 |
|
|
70 |
1 |
|
acute myocardial infarction |
no |
53 |
|
|
< 6 hours |
100 |
|
|
6 to 24 hours |
95 |
|
|
1 to 7 days |
79 |
|
previous PCI |
yes |
-12 |
|
|
no |
0 |
|
renal failure |
yes |
15 |
|
|
no |
0 |
|
COPD |
yes |
6 |
|
|
no |
0 |
|
peripheral vascular disease |
yes |
9 |
|
|
no |
0 |
where:
• One modification would be to match gaps in the ages with gaps in the point assignments.
• Renal failure, COPD and peripheral vascular disease are not weighted for severity.
• Presumably an AMI > 7 days before the PCI is scored as no AMI (53 points).
• An ejection fraction < 20% is a poor prognostic sign.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 41
• maximum score: 174
• The higher the score the greater the mortality risk.
|
Total Score |
Mortality |
|
< 62 |
< 0.6% |
|
62 to 68 |
< 0.8% |
|
69 to 115 |
(0.00175 * ((points)^2)) - (0.2334 * (points)) + 8.876 |
|
115 to 153 |
(0.00598 * ((points)^2)) - (1.215 * (points)) + 65.6 |
|
> 153 |
> 20% |
Specialty: Cardiology
ICD-10: ,
