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Original Articles

Validation of the Mayo Clinic Risk Score for In-Hospital Mortality After Percutaneous Coronary Interventions Using the National Cardiovascular Data Registry

Mandeep Singh, MD, MPH; Eric D. Peterson, MD, MPH; Sarah Milford-Beland, MS; John S. Rumsfeld, MD and John A. Spertus, MD, MPH

From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn (M.S.); Duke Clinical Research Institute, Durham, NC (S.M-B, E.P.); Mid America Heart Institute/UMKC, Kansas City, Mo (J.A.S.); and Denver VA Medical Center, Denver, Colo (J.S.R.).

Reprint requests to Dr Mandeep Singh, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail singh.mandeep{at}mayo.edu

Received November 28, 2007; accepted June 12, 2008.

Background— 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.

Methods and Results— 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.

Conclusions— 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.

Key Words: angiography • angioplasty • complications • risk factors

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CLINICAL PERSPECTIVE

Related Article

Validation of the Mayo Clinic Risk Score for In-Hospital Mortality After Percutaneous Coronary Interventions Using the National Cardiovascular Data Registry

Mandeep Singh, Eric D. Peterson, Sarah Milford-Beland, John S. Rumsfeld, and John A. Spertus
Circ Cardiovasc Interv 2008 1: 36-44. [Abstract] [Full Text] [PDF]

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