Study Validates Updated CathPCI Registry Risk Models
With the addition of high-risk patient characteristics, such as cardiogenic shock, chronic total occlusion (CTO) and recent cardiac arrest, the fourth version of the CathPCI Registry® data collection form (DCF v4) mortality models continued to accurately predict outcomes across the risk spectrum of patients undergoing percutaneous coronary intervention (PCI). In DCF v4, clinical acuity continues to be a strong predictor of PCI procedural mortality, according to a study published in JACC: Cardiovascular Interventions.
DCF v4 was based on 1,208,137 elective and urgent PCI procedures performed at 1,252 sites participating in the CathPCI Registry between July 2009 and June 2011. In-hospital mortality ranged from 0.2 percent among elective cases to 65.9 percent for patients with shock and recent cardiac arrest. Overall, the in-hospital mortality rate was 1.4 percent. Cardiogenic shock and procedure urgency were predictive of in-hospital mortality. Angiographic findings predictive of in-hospital mortality were CTO, subacute stent thrombosis and left main lesion location. Three mortality models were developed — a complete version, a pre-catheterization version and a bedside version — all of which accurately predicted outcomes across patient subgroups and risk categories, wrote the investigators.
Multiple organizations have endorsed DCF v4 as a measure of quality care, and multiple payers for quality improvement and reward programs are using the measure. The investigators wrote that the models reflect the most current understanding of the clinical characteristics associated with PCI-related mortality, but they also caution that the registry under-represents small practices and may be subject to data collection biases.
“With the inclusion of indicators for high-risk PCI, the updated CathPCI Registry DCF v4 mortality models perform well in both low- and high-risk PCI patient populations,” they concluded. Moving forward, steps are expected to include other important high-risk characteristics, such as frailty, that are difficult to collect in quality improvement programs.
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