Risk-Adjusting Key Outcome Measures in a Clinical Quality PCI Registry: Development of a Highly Predictive Model Without the Need to Exclude High-Risk Conditions
dc.contributor.author | Tacey, M. | |
dc.contributor.author | Dinh, D.T. | |
dc.contributor.author | Andrianopoulos, N. | |
dc.contributor.author | Brennan, A.L. | |
dc.contributor.author | Stub, D. | |
dc.contributor.author | Liew, D. | |
dc.contributor.author | Reid, Christopher | |
dc.contributor.author | Duffy, S.J. | |
dc.contributor.author | Lefkovits, J. | |
dc.date.accessioned | 2023-08-30T23:30:25Z | |
dc.date.available | 2023-08-30T23:30:25Z | |
dc.date.issued | 2019 | |
dc.identifier.citation | Tacey, M. and Dinh, D.T. and Andrianopoulos, N. and Brennan, A.L. and Stub, D. and Liew, D. and Reid, C.M. et al. 2019. Risk-Adjusting Key Outcome Measures in a Clinical Quality PCI Registry: Development of a Highly Predictive Model Without the Need to Exclude High-Risk Conditions. JACC: Cardiovascular Interventions. 12 (19): pp. 1966-1975. | |
dc.identifier.uri | http://hdl.handle.net/20.500.11937/93081 | |
dc.identifier.doi | 10.1016/j.jcin.2019.07.002 | |
dc.description.abstract |
Objectives: This study sought to determine the most risk-adjustment model for 30-day all-cause mortality in order to report risk-adjusted outcomes. The study also explored whether the exclusion of extreme high-risk conditions of cardiogenic shock, intubated out-of-hospital cardiac arrest (OHCA), or the need for mechanical ventricular support affected the model's predictive accuracy. Background: Robust risk-adjustment models are a critical component of clinical quality registries, allowing outcomes to be reported in a fair and meaningful way. The Victorian Cardiac Outcomes Registry encompasses all 30 hospitals in the state of Victoria, Australia, that undertake percutaneous coronary intervention. Methods: Data were collected on 27,544 consecutive percutaneous coronary intervention procedures from 2014 to 2016. Twenty-eight patient risk factors and procedural variables were considered in the modeling process. The multivariable logistic regression analysis considered derivation and validation datasets, along with a temporal validation period. Results: The model included risk-adjustment for cardiogenic shock, intubated OHCA, estimated glomerular filtration rate, left ventricular ejection fraction, angina type, mechanical ventricular support, ≥80 years of age, lesion complexity, percutaneous access site, and peripheral vascular disease. The C-statistic for the derivation dataset was 0.921 (95% confidence interval: 0.905 to 0.936), with C-statistics of 0.931 and 0.934 for 2 validation datasets reflecting the 2014 to 2016 and 2017 periods. Subgroup modeling excluding cardiogenic shock and intubated OHCA provided similar risk-adjusted outcomes (p = 0.32). Conclusions: Our study has developed a highly predictive risk-adjustment model for 30-day mortality that included high-risk presentations. Therefore, we do not need to exclude high-risk cases in our model when determining risk-adjusted outcomes. | |
dc.language | English | |
dc.publisher | ELSEVIER SCIENCE INC | |
dc.relation.sponsoredby | http://purl.org/au-research/grants/nhmrc/1111170 | |
dc.relation.sponsoredby | http://purl.org/au-research/grants/nhmrc/1045862 | |
dc.relation.sponsoredby | http://purl.org/au-research/grants/nhmrc/1090302 | |
dc.subject | Science & Technology | |
dc.subject | Life Sciences & Biomedicine | |
dc.subject | Cardiac & Cardiovascular Systems | |
dc.subject | Cardiovascular System & Cardiology | |
dc.subject | 30-day mortality | |
dc.subject | clinical quality registry | |
dc.subject | percutaneous coronary intervention | |
dc.subject | risk-adjustment | |
dc.subject | PERCUTANEOUS CORONARY INTERVENTION | |
dc.subject | 30-DAY MORTALITY | |
dc.subject | 30-day mortality | |
dc.subject | clinical quality registry | |
dc.subject | percutaneous coronary intervention | |
dc.subject | risk-adjustment | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Cause of Death | |
dc.subject | Coronary Artery Disease | |
dc.subject | Female | |
dc.subject | Glomerular Filtration Rate | |
dc.subject | Health Status | |
dc.subject | Heart-Assist Devices | |
dc.subject | Humans | |
dc.subject | Intubation, Intratracheal | |
dc.subject | Male | |
dc.subject | Out-of-Hospital Cardiac Arrest | |
dc.subject | Percutaneous Coronary Intervention | |
dc.subject | Quality Indicators, Health Care | |
dc.subject | Registries | |
dc.subject | Reproducibility of Results | |
dc.subject | Risk Assessment | |
dc.subject | Risk Factors | |
dc.subject | Shock, Cardiogenic | |
dc.subject | Stroke Volume | |
dc.subject | Time Factors | |
dc.subject | Treatment Outcome | |
dc.subject | Ventricular Function, Left | |
dc.subject | Victoria | |
dc.subject | Humans | |
dc.subject | Shock, Cardiogenic | |
dc.subject | Stroke Volume | |
dc.subject | Glomerular Filtration Rate | |
dc.subject | Treatment Outcome | |
dc.subject | Heart-Assist Devices | |
dc.subject | Registries | |
dc.subject | Cause of Death | |
dc.subject | Risk Assessment | |
dc.subject | Risk Factors | |
dc.subject | Reproducibility of Results | |
dc.subject | Intubation, Intratracheal | |
dc.subject | Health Status | |
dc.subject | Ventricular Function, Left | |
dc.subject | Time Factors | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Quality Indicators, Health Care | |
dc.subject | Victoria | |
dc.subject | Female | |
dc.subject | Male | |
dc.subject | Coronary Artery Disease | |
dc.subject | Out-of-Hospital Cardiac Arrest | |
dc.subject | Percutaneous Coronary Intervention | |
dc.title | Risk-Adjusting Key Outcome Measures in a Clinical Quality PCI Registry: Development of a Highly Predictive Model Without the Need to Exclude High-Risk Conditions | |
dc.type | Journal Article | |
dcterms.source.volume | 12 | |
dcterms.source.number | 19 | |
dcterms.source.startPage | 1966 | |
dcterms.source.endPage | 1975 | |
dcterms.source.issn | 1936-8798 | |
dcterms.source.title | JACC: Cardiovascular Interventions | |
dc.date.updated | 2023-08-30T23:30:25Z | |
curtin.department | Curtin School of Population Health | |
curtin.accessStatus | Open access via publisher | |
curtin.faculty | Faculty of Health Sciences | |
curtin.contributor.orcid | Reid, Christopher [0000-0001-9173-3944] | |
dcterms.source.eissn | 1876-7605 | |
curtin.repositoryagreement | V3 |
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