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a Department of
Cardiology, Royal Sussex County Hospital, Eastern Road, Brighton
BN2 5BE, UK, b Department of Cardiology, King's Healthcare
Trust, Denmark Hill, London SE5 9RS, UK
Correspondence to: Dr Thomas mttwins{at}aol.com
Accepted 11 September 2000
OBJECTIVE
To create a risk model for
predicting major adverse complicating events of percutaneous
transluminal coronary angioplasty (PTCA), and to test the accuracy of
the model on a prospective cohort of patients
SETTINGTertiary cardiac centre
METHODSAvailable software can
predict probabilities of events using Bayes's theorem. To establish
the accuracy of these predictive tools, a Bayes table was created to
evaluate major adverse complicating events (MACE)death, emergency
coronary artery bypass grafting (CABG), or Q wave infarct occurring
during the in-patient episodeon the first 1500 patients in the
department PTCA database (development group); the predictive value of
this model was then tested with the subsequent 1000 patients
(evaluation group). The following probabilities were assessed to
determine their association with MACE: age, sex, left ventricular
function, American Heart Association lesion morphology classification,
cardiogenic shock, previous CABG, diabetes, hypertension, multivessel PTCA.
MAIN OUTCOME MEASURESTo establish
the discriminatory ability of the predictive index, calibration plots
and receiver operating characteristic (ROC) curves were obtained to
compare the development and evaluation groups.
RESULTSThe ROC curve plotted to
determine the discriminatory value of the Bayesian table created from
the development group (n = 1500) in predicting MACE in the evaluation
group (n = 1000) showed a moderately predictive area under the curve
of 0.76 (SEM 0.07). This predictive accuracy was confirmed with
separately constructed calibration plots.
CONCLUSIONSAccurate predictions of
MACE can be identified in populations undergoing percutaneous
intervention. The database used allows operators to obtain consent from
patients appropriately from their own experience rather than from other
published data. If a national PTCA database existed along similar
lines, individual operators and interventional centres could compare
themselves with nationally available data.
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B Kunadian, J Dunning, R Das, A P Roberts, R Morley, A J Turley, D Twomey, J A Hall, R A Wright, A G C Sutton, et al. External validation of established risk adjustment models for procedural complications after percutaneous coronary intervention Heart, August 1, 2008; 94(8): 1012 - 1018. [Abstract] [Full Text] [PDF]
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A D Grayson, R K Moore, M Jackson, S Rathore, S Sastry, T P Gray, I Schofield, A Chauhan, F F Ordoubadi, B Prendergast, et al. Multivariate prediction of major adverse cardiac events after 9914 percutaneous coronary interventions in the north west of England Heart, May 1, 2006; 92(5): 658 - 663. [Abstract] [Full Text] [PDF]
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