TCT-219 Performance of Existing Risk Models in Impella-Supported High-Risk Percutaneous Coronary Intervention

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Background: High-risk percutaneous coronary intervention (HRPCI) procedures supported by percutaneous left ventricular assist devices are becoming increasingly common. To make the most informed decisions, it is important to be able to accurately assess risk before these interventions. Methods: PROTECT III is a prospective, multicenter, observational study enrolling consecutive patients undergoing Impella-supported HRPCI at 46 U.S. centers. Major adverse cardiac and cerebrovascular events—the composite of death, myocardial infarction, stroke/transient ischemic attack, or repeat revascularization—were adjudicated by an independent clinical events committee. Two existing risk scores were applied for each patient: the National Cardiovascular Data Registry bedside risk score (for in-hospital mortality) and the British Cardiovascular Intervention Society Complex High-Risk Indicated PCI (BCIS-CHIP) risk score (for major adverse cardiac and cerebrovascular events). Results: Performance of the 2 risk scores (observed vs expected event rates by risk decile) are displayed in Figure 1, with both models showing poor calibration. The National Cardiovascular Data Registry risk score had moderate discrimination (c-index 0.71; 95% CI: 0.69-0.73) while the BCIS-CHIP risk score had poor discrimination (c-index 0.61; 95% CI: 0.59-0.64). [Formula presented] Conclusion: Existing risk scores perform relatively poorly in contemporary patients undergoing percutaneous left ventricular assist device–supported HRPCI. Risk scores designed specifically for this population are needed to support optimal clinical decision-making. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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