British Investigators Develop a Risk-Scoring System to Predict 30‐Day Outcomes of PCI in Octogenarians

December 6, 2020—James Cockburn, MD, et al with the British Cardiovascular Intervention Society created a 30‐day mortality risk model for octogenarians presenting with both acute coronary syndrome and chronic stable angina to predict outcomes of percutaneous coronary intervention (PCI). The risk-scoring system was presented in Catheterization and Cardiovascular Interventions (CCI).

The investigators noted in CCI that octogenarians are a high‐risk group presenting for PCI, and decisions about whether or not to undertake intervention in this cohort can be challenging. They further explained that the increasing number of octogenarians in the general population means they represent an important high‐risk patient subgroup.

As summarized in CCI, the investigators used comprehensive mandatory United Kingdom data submissions to the United Kingdom national database. The data group consisted of 425,897 PCI procedures undertaken in the United Kingdom between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥ 80 years. These patients comprised the model group.

The CCI abstract noted that logistic regression was used to create a predictive score, which ultimately consisted of the following weightings: age 80 to 89 (n = 1); age >  90 (n = 2); unstable angina/non–ST‐segment elevation myocardial infarction (NSTEMI) (n = 1); STEMI (n = 2); creatinine > 200 mmol/L (n = 1); preprocedural ventilation (n = 1); left ventricular ejection fraction < 30% (n = 1); and cardiogenic shock (n = 2). Multiple imputation was used to account for missing data.

The patient cohort was divided into a derivation (n = 22,072) and a validation data set (n = 22,071). Receiver operating characteristic analyses were used to derive the area under the curve (AUC) to assess properties of the score.

The investigators reported the following findings in CCI:

• The scoring system generated an AUC of 0.83 (95% CI, 0.80-0.85), suggesting high sensitivity and specificity.
• Scores of 1 to 4 were associated with good survival, but scores ≥ 5 were associated with an estimated likelihood of death within 30 days of ≥ 40%.

“This octogenarian risk score may be a useful tool to determine the chance of a successful outcome in elderly patients presenting for PCI,” concluded the investigators in CCI.