Maynard et al identified risk factors affecting hospital mortality in patients undergoing percutaneous coronary intervention (PCI). This can help evaluate patients prior to the procedure and to compare outcomes. The authors participated in the Clinical Outcomes Assessment Program (COAP) and are from the University of Washington (Seattle), the Pugent Sound Veterans Administration Healthcare System and Dartmouth-Hitchcock Medical Center (Dartmouth, NH).
Outcome: hospital mortality
Parameters:
(1) age in years
(2) gender
(3) history of COPD
(4) history of peripheral vascular disease
(5) history of previous PCI
(6) history of congestive heart failure (CHF)
(7) presence of cardiogenic shock
(8) timing for the procedure (elective vs nonelective)
(9) serum creatinine
(10) left ventricular ejection fraction (LVEF)
(11) number of diseased coronary arteries
(12) myocardial infarction < 24 hours from admission (in the text on page 659 phrased as myocardial infarction occurred < 24 hours before the PCI)
|
Parameter
|
Finding
|
Points
|
|
age in years
|
per 10 year increase
|
(age) / 10 * 0.052
|
|
gender
|
female
|
0
|
|
|
male
|
-0.372
|
|
history of COPD
|
no
|
0
|
|
|
yes
|
0.571
|
|
history of peripheral vascular disease
|
no
|
0
|
|
|
yes
|
0.494
|
|
history of previous PCI
|
no
|
0
|
|
|
yes
|
-0.491
|
|
history of CHF
|
no
|
0
|
|
|
yes
|
0.451
|
|
cardiogenic shock
|
absent
|
0
|
|
|
present
|
2.282
|
|
procedure timing
|
elective
|
0
|
|
|
non-elective (emergent)
|
1.471
|
|
serum creatinine
|
<= 2.0 mg/dL
|
0
|
|
|
> 2.0 mg/dL
|
1.264
|
|
LVEF
|
unspecified
|
0.980
|
|
|
>= 30%
|
0
|
|
|
< 30%
|
1.202
|
|
number of disease coronary arteries
|
0 to 3
|
(number) * 0.437
|
|
time between AMI and procedure
|
>= 24 hours
|
0
|
|
|
< 24 hours
|
0.579
|
where:
• Age is handled "per 10 year increase". This can be done as INTEGER((age) / 10), ROUND((age) / 10,0) or (age)/10.
• The number of diseased vessels was from 0 to 3. 1 point is assigned for > 70% involvement in the right, left circumflex or left anterior descending arteries. 2 points are assigned for > 70% involvement in left main coronary artery. My guess is that disease in the left circumflex or left anterior descending is not scored if there is left main involvement.
total score = X =
= SUM(points for all 12 parameters) - 10.435
probability of hospital mortality =
= 1 / (1 + EXP((-1) * X))
