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In‐hospital mortality risk prediction after percutaneous coronary interventions: Validating and updating the toronto score in Brazil
Author(s) -
LodiJunqueira 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.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25916
Subject(s) - medicine , psychological intervention , percutaneous , percutaneous coronary intervention , framingham risk score , emergency medicine , cardiology , intensive care medicine , medical emergency , myocardial infarction , disease , psychiatry
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. © 2015 Wiley Periodicals, Inc.