Risk scores do not adjust for aggressive, evidence-based changes in percutaneous coronary intervention practice patterns

Future Cardiology
Steven Es MinerBrian W McCrindle

Abstract

Public reporting of procedural outcomes leads to risk averse behavior because physicians do not believe the scores account for patient risk. We investigated the effects of more aggressive percutaneous coronary intervention (PCI) practice on risk-adjusted mortality. 8935 PCI were performed. Risk adjustment was performed with the New York State PCI risk score. The cohort was divided into two eras based on programs implemented to promote more aggressive care. Between eras, overall adjusted mortality ratios rose from 0.66 to 0.90 (observed/predicted, p = 0.02), despite evidence supporting consistent procedural quality. Evidence-based changes in PCI practice were associated with worsening risk-adjusted procedural mortality. These data are consistent with physician beliefs regarding risk-adjusted outcome measures.

References

Jan 12, 2005·Archives of Internal Medicine·Craig R NarinsWojciech Zareba
Jun 2, 2005·JAMA : the Journal of the American Medical Association·David M StuddertTroyen A Brennan
Jun 7, 2005·Journal of the American College of Cardiology·Zoltan G Turi
Nov 26, 2005·Annals of Emergency Medicine·David A KatzHarry P Selker
Feb 7, 2006·Journal of the American College of Cardiology·Chuntao WuRobert H Jones
Mar 7, 2009·Journal of the American College of Cardiology·Frederic S Resnic, Frederick G P Welt
Mar 7, 2009·Journal of the American College of Cardiology·Robert M Califf, Eric D Peterson
Nov 10, 2009·The Canadian Journal of Cardiology·S JedrzkiewiczUNKNOWN Canadian Global Registry of Acute Coronary Events (GRACE/GRACE2)
Nov 20, 2009·JAMA : the Journal of the American Medical Association·Jack V TuDennis T Ko
May 1, 2010·Journal of the American College of Cardiology·Eric D PetersonUNKNOWN NCDR Registry Participants
Sep 23, 2010·Circulation. Cardiovascular Interventions·Amanda StebbinsUNKNOWN Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI Investigators)
Sep 22, 2012·JACC. Cardiovascular Interventions·Josep Rodés-Cabau, Michael Mok

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Citations

Jun 20, 2015·JACC. Cardiovascular Interventions·Steve Miner, Lynne Nield

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