Mayo Clinic, Rochester, MN 55905, USA.
Circ Cardiovasc Interv. 2008 Aug;1(1):36-44. doi: 10.1161/CIRCINTERVENTIONS.107.755991.
We sought to validate the recently developed Mayo Clinic Risk Score model for in-hospital mortality after percutaneous coronary intervention using an independent data set. The Mayo Clinic Risk Score has 7 simple clinical and noninvasive variables, available before coronary angiography, for prediction of in-hospital mortality. External validation using an independent data set would support broader applicability of the model.
In-hospital mortality after percutaneous coronary intervention on 309 351 patients from the National Cardiovascular Data Registry admitted from January 1, 2004, to March, 30, 2006, was studied. Using the Mayo Clinic Risk Score equation, we assigned predicted probabilities of death to each patient. The area under the receiver-operating characteristics curve was 0.884, indicating excellent discrimination overall as well as among subgroups, including gender, diabetes mellitus, renal failure, low ejection fraction, different age groups, and multivessel disease. Ninety-seven percent of patients undergoing percutaneous coronary intervention had a Mayo Clinic Risk Score <10, indicating low to intermediate risk. The Mayo Clinic Risk Score model initially slightly underpredicted event rates when applied in National Cardiovascular Data Registry data (observed 1.23% versus predicted 1.10%), but this underprediction was corrected after recalibration. The recalibrated risk score discriminated (c index=0.885) and calibrated well in an National Cardiovascular Data Registry validation data set consisting of procedures performed between April 1, 2006, and March 30, 2007.
Seven variables can be combined into a convenient risk scoring system before coronary angiography is performed to predict in-hospital mortality after percutaneous coronary intervention. This model may be useful for providing patients with individualized, evidence-based estimates of procedural risk as part of the informed consent process before percutaneous coronary intervention.
我们试图使用独立数据集验证最近开发的梅奥诊所风险评分模型在经皮冠状动脉介入治疗后的院内死亡率。梅奥诊所风险评分有 7 个简单的临床和非侵入性变量，可在冠状动脉造影前获得，用于预测院内死亡率。使用独立数据集进行外部验证将支持该模型更广泛的适用性。
研究了 2004 年 1 月 1 日至 2006 年 3 月 30 日期间全国心血管数据注册中心接受的 309351 例经皮冠状动脉介入治疗后院内死亡率。使用梅奥诊所风险评分方程，我们为每位患者分配了死亡的预测概率。受试者工作特征曲线下面积为 0.884，表明总体以及包括性别、糖尿病、肾衰竭、射血分数低、不同年龄组和多血管疾病在内的亚组的区分度均较好。97%接受经皮冠状动脉介入治疗的患者梅奥诊所风险评分<10，表明风险低至中等。当梅奥诊所风险评分模型应用于全国心血管数据注册中心数据时，最初略微低估了事件发生率（观察到的 1.23%与预测的 1.10%），但在重新校准后纠正了这种低估。重新校准的风险评分在 2006 年 4 月 1 日至 2007 年 3 月 30 日期间进行的程序组成的全国心血管数据注册中心验证数据集中具有良好的区分度（c 指数=0.885）和校准度。
可以在进行冠状动脉造影之前将七个变量组合成一个方便的风险评分系统，以预测经皮冠状动脉介入治疗后的院内死亡率。该模型可用于为患者提供个体化、基于证据的手术风险估计，作为经皮冠状动脉介入治疗前知情同意过程的一部分。
