Author + information
- Received January 25, 1995
- Revision received May 16, 1995
- Accepted May 25, 1995
- Published online October 1, 1995.
- Stephen E. Kimmel, MS, MD*,†,*,1,
- Jesse A. Berlin, ScD†,
- Brian L. Strom, MD, MPH† and
- Warren K. Laskey, MD, FACC*,*,†
- ↵*Address for correspondence: Dr. Stephen E. Kimmel. University of Pennsylvania School of Medicine, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, Pennsylvania 19104-6021.
- ↵†Address for reprints: Dr. Warren K. Laskey, Society for Cardiac Angiography and Interventions. P.O. Box 7849, Breckenridge, Colorado 80424.
Objectives. This study was designed to determine the preprocedural risk factors for major complications (emergent coronary bypass surgery, myocardial infarction or death) of coronary angioplasty and to derive and validate a simplified index that predicts patients' a priori risk of complications.
Background. Previous studies of risk factors for complications after coronary angioplasty may not be generalizable to current, broad-based angioplasty practice. Furthermore, to our knowledge a clinically useful predictive index has not been derived and independently validated.
Methods. From data collected prospectively for the Registry of the Society for Cardiac Angiography and Interventions for 1992, multivariable logistic regression was used to determine which variables were independently associated with complications in 10,622 first angioplasty procedures. Stepwise regression and receiver operating characteristic curves then were used in this registry to develop a predictive index for complications that was validated using 5,250 first angioplasty procedures in the 1993 registry.
Results. Predictors of major complications were multivessel disease, unstable angina, recent myocardial infarction, type C lesion or left main angioplasty, shock, age, geographic region and absence of previous coronary bypass surgery. The derived predictive index consisted of the first six of these variables plus aortic valve disease and classified patients into four risk groups: low (1.3% complications), moderate (2.8%), high (12.7%) and very high (29.7%) risk. This index demonstrated consistent reliability and discriminatory ability when applied to the 1993 data.
Conclusions. Predictors of major complications identified in selected populations also apply currently in broad-based practice. From these variables, a predictive index can stratify patients into risk groups before angioplasty, thus aiding in risk assessment, resource allocation and risk adjustment.
for the Registry Committee of the Society for Cardiac Angiography and Interventions
↵1 At the time of this work, Dr. Kimmel was supported in part as a Merck Fellow of the American College of Cardiology, Bethesda. Maryland.
This study was presented in part at the 17th Annual Meeting of the Society for Cardiac Angiography and Interventions, Seattle, Washington, May 1994.
- Received January 25, 1995.
- Revision received May 16, 1995.
- Accepted May 25, 1995.
- American College of Cardiology