经皮冠状动脉介入治疗后的院内死亡风险预测：在巴西验证和更新多伦多评分

In-hospital mortality risk prediction after percutaneous coronary interventions: Validating and updating the Toronto score in Brazil.

作者信息

Lodi-Junqueira Lucas, da Silva José L P, Ferreira Lorena R, Gonçalves Humberto L, Athayde Guilherme R S, Gomes Thalles O, Borges Júlio C, Nascimento Bruno R, Lemos Pedro A, Ribeiro Antônio L P

机构信息

Department of Interventional Cardiology, Hospital Das Clínicas, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.

Department of Statistics, Institute of Exact Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.

出版信息

Catheter Cardiovasc Interv. 2015 Nov 15;86(6):E239-46. doi: 10.1002/ccd.25916. Epub 2015 Jul 2.

DOI:10.1002/ccd.25916

PMID:25754488

Abstract

OBJECTIVES

We aimed to assess the accuracy of the simple, contemporary and well-designed Toronto PCI mortality risk score in ICP-BR registry, the first Brazilian PCI multicenter registry with follow-up information.

BACKGROUND

Estimating percutaneous coronary intervention (PCI) mortality risk by a clinical prediction model is imperative to help physicians, patients and family members make informed clinical decisions and optimize participation in the consent process, reducing anxiety and improving quality of care. At a healthcare system level, risk prediction scores are essential to measure and benchmark performance.

METHODS

Between 2009 and 2013, a cohort of 4,806 patients from the ICP-BR registry, treated with PCI in eight tertiary referral medical centers, was included in the analysis. This population was compared to 10,694 patients of the derivation dataset from the Toronto study. To assess predictive performance, an update of the model was performed by three different methods, which were compared by discrimination, calculating the area under the receiver operating characteristic curve (AUC), and by calibration, assessed through Hosmer-Lemeshow (H-L) test and graphical analysis.

RESULTS

Death occurred in 2.6% of patients in the ICP-BR registry and in 1.3% in the Toronto cohort. The median age was 64 and 63 years, 23.8 and 32.8% were female, 28.6 and 32.3% were diabetics, respectively. Through recalibration of intercept and slope (AUC = 0.8790; H-L P value = 0.3132), we achieved a well-calibrated and well-discriminative model.

CONCLUSIONS

After updating to our dataset, we demonstrated that the Toronto PCI in-hospital mortality risk score performed well in Brazilian hospitals.

摘要

目的

我们旨在评估简单、现代且设计良好的多伦多PCI死亡风险评分在ICP - BR注册研究中的准确性，该注册研究是巴西首个有随访信息的PCI多中心注册研究。

背景

通过临床预测模型评估经皮冠状动脉介入治疗（PCI）的死亡风险对于帮助医生、患者及其家属做出明智的临床决策以及优化参与同意过程、减轻焦虑和提高医疗质量至关重要。在医疗系统层面，风险预测评分对于衡量和评估医疗表现至关重要。

方法

2009年至2013年期间，来自ICP - BR注册研究的4806例在八个三级转诊医疗中心接受PCI治疗的患者被纳入分析。该人群与多伦多研究衍生数据集的10694例患者进行比较。为评估预测性能，通过三种不同方法对模型进行更新，并通过辨别力（计算受试者操作特征曲线下面积（AUC））以及校准（通过Hosmer - Lemeshow（H - L）检验和图形分析进行评估）对这三种方法进行比较。

结果

ICP - BR注册研究中的患者死亡率为2.6%，多伦多队列中的患者死亡率为1.3%。中位年龄分别为64岁和63岁，女性分别占23.8%和32.8%，糖尿病患者分别占28.6%和32.3%。通过重新校准截距和斜率（AUC = 0.8790；H - L P值 = 0.3132），我们得到了一个校准良好且辨别力良好的模型。