Performance of currently available risk models in a cohort of mechanically supported high-risk percutaneous coronary intervention - From the PROTECT II randomized trial

José P.S. Henriques, Bimmer E. Claessen, George D. Dangas, Ajay J. Kirtane, Jeffrey J. Popma, Joseph M. Massaro, Barry Cohen, E. Magnus Ohman, Jeffrey W. Moses, William W. O'Neill

Research output: Contribution to journalArticle

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Abstract

Background: Procedural risk scores facilitate clinical decision making by using individual patient characteristics to estimate the risk of adverse events. The performance of PCI-based risk scores is not well-described among patients undergoing hemodynamically supported high risk PCI. Methods and results: A total of 427 patients with unprotected left main disease, last remaining vessel or threevessel disease with severely reduced left ventricular function underwent supported high-risk PCI with an intra-aortic balloon pump (IABP, N = 211) or a left ventricular assist device (Impella 2.5, N = 216) as part of the PROTECT II trial. We examined the performance of the additive Euroscore, logistic Euroscore, STS mortality score, STS morbidity and mortality score, Mayo Clinic risk score and New York state PCI risk score on the endpoint of 90-day mortality in this unique high-risk population. Mean age was 67.2 ± 10.9 years; 65.8% of patients were in NYHA class III/IV, and mean LVEF was 24%. All-cause 90-day mortality was 10.4%. The scores were generally correlated (p < 0.0001 for all comparisons), with R2 values ranging from 0.28 (STS morbidity/mortality and Mayo Clinic) to 0.68 (logistic Euroscore and STS mortality). However, receiver-operator curves for 90-day all-cause mortality for all risk scores demonstrated poor discriminatory performance with c-statistics of 0.542-0.616. Calibration of the risk scores was not poor, but varied according to the specific score examined. Conclusion: The discriminatory capacity of currently available risk models is suboptimal when applied to a cohort of mechanically supported complex high-risk PCI. A risk score designed specifically for this population could help to further refine risk assessment.

Original languageEnglish (US)
Pages (from-to)272-278
Number of pages7
JournalInternational Journal of Cardiology
Volume189
Issue number1
DOIs
StatePublished - Aug 1 2015

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Percutaneous Coronary Intervention
Mortality
Morbidity
Heart-Assist Devices
Left Ventricular Function
Calibration
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Henriques, José P.S. ; Claessen, Bimmer E. ; Dangas, George D. ; Kirtane, Ajay J. ; Popma, Jeffrey J. ; Massaro, Joseph M. ; Cohen, Barry ; Ohman, E. Magnus ; Moses, Jeffrey W. ; O'Neill, William W. / Performance of currently available risk models in a cohort of mechanically supported high-risk percutaneous coronary intervention - From the PROTECT II randomized trial. In: International Journal of Cardiology. 2015 ; Vol. 189, No. 1. pp. 272-278.
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abstract = "Background: Procedural risk scores facilitate clinical decision making by using individual patient characteristics to estimate the risk of adverse events. The performance of PCI-based risk scores is not well-described among patients undergoing hemodynamically supported high risk PCI. Methods and results: A total of 427 patients with unprotected left main disease, last remaining vessel or threevessel disease with severely reduced left ventricular function underwent supported high-risk PCI with an intra-aortic balloon pump (IABP, N = 211) or a left ventricular assist device (Impella 2.5, N = 216) as part of the PROTECT II trial. We examined the performance of the additive Euroscore, logistic Euroscore, STS mortality score, STS morbidity and mortality score, Mayo Clinic risk score and New York state PCI risk score on the endpoint of 90-day mortality in this unique high-risk population. Mean age was 67.2 ± 10.9 years; 65.8{\%} of patients were in NYHA class III/IV, and mean LVEF was 24{\%}. All-cause 90-day mortality was 10.4{\%}. The scores were generally correlated (p < 0.0001 for all comparisons), with R2 values ranging from 0.28 (STS morbidity/mortality and Mayo Clinic) to 0.68 (logistic Euroscore and STS mortality). However, receiver-operator curves for 90-day all-cause mortality for all risk scores demonstrated poor discriminatory performance with c-statistics of 0.542-0.616. Calibration of the risk scores was not poor, but varied according to the specific score examined. Conclusion: The discriminatory capacity of currently available risk models is suboptimal when applied to a cohort of mechanically supported complex high-risk PCI. A risk score designed specifically for this population could help to further refine risk assessment.",
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Performance of currently available risk models in a cohort of mechanically supported high-risk percutaneous coronary intervention - From the PROTECT II randomized trial. / Henriques, José P.S.; Claessen, Bimmer E.; Dangas, George D.; Kirtane, Ajay J.; Popma, Jeffrey J.; Massaro, Joseph M.; Cohen, Barry; Ohman, E. Magnus; Moses, Jeffrey W.; O'Neill, William W.

In: International Journal of Cardiology, Vol. 189, No. 1, 01.08.2015, p. 272-278.

Research output: Contribution to journalArticle

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T1 - Performance of currently available risk models in a cohort of mechanically supported high-risk percutaneous coronary intervention - From the PROTECT II randomized trial

AU - Henriques, José P.S.

AU - Claessen, Bimmer E.

AU - Dangas, George D.

AU - Kirtane, Ajay J.

AU - Popma, Jeffrey J.

AU - Massaro, Joseph M.

AU - Cohen, Barry

AU - Ohman, E. Magnus

AU - Moses, Jeffrey W.

AU - O'Neill, William W.

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N2 - Background: Procedural risk scores facilitate clinical decision making by using individual patient characteristics to estimate the risk of adverse events. The performance of PCI-based risk scores is not well-described among patients undergoing hemodynamically supported high risk PCI. Methods and results: A total of 427 patients with unprotected left main disease, last remaining vessel or threevessel disease with severely reduced left ventricular function underwent supported high-risk PCI with an intra-aortic balloon pump (IABP, N = 211) or a left ventricular assist device (Impella 2.5, N = 216) as part of the PROTECT II trial. We examined the performance of the additive Euroscore, logistic Euroscore, STS mortality score, STS morbidity and mortality score, Mayo Clinic risk score and New York state PCI risk score on the endpoint of 90-day mortality in this unique high-risk population. Mean age was 67.2 ± 10.9 years; 65.8% of patients were in NYHA class III/IV, and mean LVEF was 24%. All-cause 90-day mortality was 10.4%. The scores were generally correlated (p < 0.0001 for all comparisons), with R2 values ranging from 0.28 (STS morbidity/mortality and Mayo Clinic) to 0.68 (logistic Euroscore and STS mortality). However, receiver-operator curves for 90-day all-cause mortality for all risk scores demonstrated poor discriminatory performance with c-statistics of 0.542-0.616. Calibration of the risk scores was not poor, but varied according to the specific score examined. Conclusion: The discriminatory capacity of currently available risk models is suboptimal when applied to a cohort of mechanically supported complex high-risk PCI. A risk score designed specifically for this population could help to further refine risk assessment.

AB - Background: Procedural risk scores facilitate clinical decision making by using individual patient characteristics to estimate the risk of adverse events. The performance of PCI-based risk scores is not well-described among patients undergoing hemodynamically supported high risk PCI. Methods and results: A total of 427 patients with unprotected left main disease, last remaining vessel or threevessel disease with severely reduced left ventricular function underwent supported high-risk PCI with an intra-aortic balloon pump (IABP, N = 211) or a left ventricular assist device (Impella 2.5, N = 216) as part of the PROTECT II trial. We examined the performance of the additive Euroscore, logistic Euroscore, STS mortality score, STS morbidity and mortality score, Mayo Clinic risk score and New York state PCI risk score on the endpoint of 90-day mortality in this unique high-risk population. Mean age was 67.2 ± 10.9 years; 65.8% of patients were in NYHA class III/IV, and mean LVEF was 24%. All-cause 90-day mortality was 10.4%. The scores were generally correlated (p < 0.0001 for all comparisons), with R2 values ranging from 0.28 (STS morbidity/mortality and Mayo Clinic) to 0.68 (logistic Euroscore and STS mortality). However, receiver-operator curves for 90-day all-cause mortality for all risk scores demonstrated poor discriminatory performance with c-statistics of 0.542-0.616. Calibration of the risk scores was not poor, but varied according to the specific score examined. Conclusion: The discriminatory capacity of currently available risk models is suboptimal when applied to a cohort of mechanically supported complex high-risk PCI. A risk score designed specifically for this population could help to further refine risk assessment.

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