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Modeling Major Adverse Outcomes of Pediatric and Adult Patients with Congenital Heart Disease Undergoing Cardiac Catheterization: Observations from the NCDR IMPACT Registry
Circulation ( IF 37.8 ) Pub Date : 2017-09-07 , DOI: 10.1161/circulationaha.117.027714
Natalie Jayaram 1 , John A. Spertus 2 , Kevin F. Kennedy 2 , Robert Vincent 3 , Gerard R. Martin 4 , Jeptha P. Curtis 5 , David Nykanen 6 , Phillip M. Moore 7 , Lisa Bergersen 8
Affiliation  

Background—Risk-standardization for adverse events following congenital cardiac catheterization is needed to equitably compare patient outcomes among different hospitals as a foundation for quality improvement. The goal of this project was to develop a risk-standardization methodology to adjust for patient characteristics when comparing major adverse outcomes in the NCDR® IMPACTTM (Improving Pediatric and Adult Congenital Treatment) Registry.Methods—39,725 consecutive patients within IMPACT undergoing cardiac catheterization between January 2011 and March 2014 were identified. Given the heterogeneity of interventional procedures for congenital heart disease, new procedure-type risk categories were derived with empiric data and expert opinion, as were markers of hemodynamic vulnerability. A multivariable hierarchical logistic regression model to identify patient and procedural characteristics predictive of a major adverse event (MAE) or death following cardiac catheterization was derived in 70% of the cohort and validated in the remaining 30%.Results—The rate of MAE or death was 7.1% and 7.2% in the derivation and validation cohorts, respectively. Six procedure-type risk categories and six independent indicators of hemodynamic vulnerability were identified. The final risk adjustment model included procedure-type risk category, number of hemodynamic vulnerability indicators, renal insufficiency, single-ventricle physiology, and coagulation disorder. The model had good discrimination with a C-statistic of 0.76 and 0.75 in the derivation and validation cohorts, respectively. Model calibration in the validation cohort was excellent with a slope of 0.97 (standard error [SE] 0.04; p-value [for difference from 1]= 0.53) and an intercept of 0.007 (SE 0.12; p-value [for difference from 0]= 0.95).Conclusions—The creation of a validated risk-standardization model for adverse outcomes following congenital cardiac catheterization can support reporting of risk-adjusted outcomes in the IMPACT Registry as a foundation for quality improvement.


中文翻译:

对小儿和成年先天性心脏病患者行心脏导管插入术的主要不良后果进行建模:来自NCDR IMPACT注册中心的观察

背景-先天性心脏导管插入术后不良事件的风险标准化需要公平地比较不同医院之间的患者结果,作为改善质量的基础。该项目的目的是开发一种风险标准化方法,以在NCDR®IMPACT TM(改善儿科和成人先天性治疗)注册簿中比较主要不良结局时调整患者特征。方法在2011年1月至2014年3月之间,IMPACT内有39725例患者接受了心脏导管检查。鉴于先天性心脏病干预程序的异质性,根据经验数据和专家意见得出了新的程序类型风险类别,以及血流动力学脆弱性的标志。该人群中有70%的人采用了多变量分层Logistic回归模型,以识别可预测主要不良事件(MAE)或心脏导管插入术后死亡的患者和程序特征,其余30%的人对此进行了验证。结果-在衍生和验证队列中,MAE或死亡的比率分别为7.1%和7.2%。确定了六个程序类型的风险类别和六个独立的血液动力学脆弱性指标。最终的风险调整模型包括程序类型的风险类别,血液动力学脆弱性指标的数量,肾功能不全,单心室生理和凝血功能障碍。该模型具有良好的判别力,在派生和验证队列中的C统计量分别为0.76和0.75。验证队列中的模型校准非常出色,其斜率为0.97(标准误差[SE] 0.04; p值[对于与1的差] = 0.53)和截距为0.007(SE 0.12; p值[对于与0的差] ] = 0.95)。结论-为先天性心脏导管插入术后不良后果创建经过验证的风险标准化模型,可以支持IMPACT注册中心报告经过风险调整的结果,以此作为提高质量的基础。
更新日期:2017-09-07
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