Summary of PCI with ACS Model based on California Inpatient and Outpatient Data, 2020-2021
Outcome: MACCE-90 (Multiple Adverse Cardiovascular and Cerebral Events within 90 Days of PCI)
This outcome is determined based on the occurrence of 1 or more of the following events within 90 days of the PCI date:
Only patients are included who did not leave against medical advice, who were residents of California at the time of the PCI, and who had PCI prior to 2021-10-02.
- Death during the PCI admission or during an emergency department encounter or inpatient re-admission within 90 days of the PCI; IP disposition code (prior 2015) '11' or (2015 or later) '20' is used to identify in-hospital deaths; disposition code '20' is used to identify ED deaths.
- Post OP Myocardial Infarction (MI) defined as MI during the PCI admission that was not present at admission or an MI during an inpatient re-admission within 90 days of PCI; ICD-9-CM codes used to identify MIs: 410.xx. ICD-10-CM codes used to identify MIs: I21.0x, I21.1x, I21.2x, I21.3, I22.0, I22.1, I22.8, I22.9, I21.4, I22.2.
- Post OP Stroke defined as stroke during the PCI admission that was not present at admission or stroke during an inpatient re-admission within 90 days of PCI; ICD-9-CM codes used to identify Strokes: 997.02, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91. ICD-10-CM codes used to identify Strokes: I63.xx, G97.31, G97.32, I97.81x, I97.82x.
- Re-Intervention defined as any cardiac surgery / intervention during the index PCI admission that occurred at least 1 day after the index PCI or a cardiac surgery / intervention during an inpatient re-admission within 90 days of PCI The following situations are considered re-interventions: Any procedure in the ICD-9-PCS range 35.xx-38.xx or ICD-10-PCS 02xxxxx that was performed using ECC (ICD-9-PCS code: 39.61, ICD-10-PCS codes: 5A1221Z) or off-pump CABG procedure (ICD-9-PCS: 36.1x, ICD-10-PCS: 0210xxx, 0211xxx, 0212xxx, 0213xxx) or TAVR (ICD-9-PCS: 35.05, 35.06, ICD-10-PCS: 02RF3xx, X2RF3xx). Any PCI (ICD-9-PCS for IP data: 36.01, 36.02, 36.05, 36.06, 36.09, 00.66; ICD-10-PCS for IP data: 02703xx, 02713xx, 02723xx, 02733xx, 02C03xx, 02C13xx, 02C23xx, 02C33xx, X2C03xx, X2C13xx, X2C23xx, X2C33xx, 02704xx, 02714xx, 02724xx, 02734xx, 02C04xx, 02C14xx, 02C24xx, 02C34xx, X2C04xx, X2C14xx, X2C24xx, X2C34xx; CPT codes for ED data for 2012 or earlier: 92980, 92981, 92982, 92983, 92984, 92995, 92996; CPT codes for ED data for 2013: 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944).
Only patients are included who did not leave against medical advice, who were residents of California at the time of the PCI, and who had PCI prior to 2021-10-02.
Model Statistics:
Number of Observations: 47,504
% of Observations with Outcome: 10.4%
C-statistic: 0.742
Pseudo-R2: 15.0
Hosmer-Lemeshow P-Value: 0.000
Model Details:
Risk Factor | N Cases | % Events | Estimate | Standard Error | Wald Chi2 | P-value | Odds Ratio (OR) | Lower 95% CL for OR | Upper 95% CL for OR | |
---|---|---|---|---|---|---|---|---|---|---|
Intercept | -3.2 | 0.1 | 2963.9 | 0.000 | ||||||
Age at Admission | 18-<50 | 4,903 | 6.9 | -0.3 | 0.1 | 11.7 | 0.001 | 0.8 | 0.7 | 0.9 |
50-<55 | 4,127 | 7.4 | -0.2 | 0.1 | 7.5 | 0.006 | 0.8 | 0.7 | 0.9 | |
55-<60 | 5,985 | 8.0 | -0.1 | 0.1 | 3.2 | 0.076 | 0.9 | 0.8 | 1.0 | |
60-<65 | 7,124 | 9.5 | 0.0 | 0.1 | 0.0 | 0.831 | 1.0 | 0.9 | 1.1 | |
65-<70 | 6,733 | 9.9 | Reference | |||||||
70-<75 | 6,379 | 10.9 | 0.0 | 0.1 | 0.6 | 0.430 | 1.1 | 0.9 | 1.2 | |
75-<80 | 5,019 | 12.6 | 0.2 | 0.1 | 6.7 | 0.010 | 1.2 | 1.0 | 1.3 | |
80 or older | 7,234 | 15.8 | 0.4 | 0.1 | 53.7 | 0.000 | 1.5 | 1.4 | 1.7 | |
Patient Sex | Male | 33,893 | 9.7 | Reference | ||||||
Female | 13,611 | 12.0 | 0.1 | 0.0 | 4.4 | 0.036 | 1.1 | 1.0 | 1.2 | |
Patient Race | White | 23,751 | 9.7 | Reference | ||||||
Non-White | 23,753 | 11.1 | 0.2 | 0.0 | 23.9 | 0.000 | 1.2 | 1.1 | 1.3 | |
Underweight / Weight Loss | 1,107 | 27.4 | 0.8 | 0.1 | 114.3 | 0.000 | 2.3 | 2.0 | 2.7 | |
Acute MI Present at Scheduled Admission | 3,463 | 6.1 | -0.3 | 0.1 | 9.9 | 0.002 | 0.8 | 0.7 | 0.9 | |
Atrial Fibrillation and Flutter | 6,560 | 16.1 | 0.2 | 0.0 | 19.6 | 0.000 | 1.2 | 1.1 | 1.3 | |
Cardiogenic Shock | 3,424 | 36.2 | 1.7 | 0.0 | 1498.8 | 0.000 | 5.5 | 5.0 | 6.0 | |
Cardiomyopathy | 2,021 | 15.8 | 0.1 | 0.1 | 2.2 | 0.138 | 1.1 | 1.0 | 1.3 | |
Heart Failure | 15,438 | 16.5 | 0.5 | 0.0 | 184.8 | 0.000 | 1.6 | 1.5 | 1.8 | |
HX Sudden Cardiac Arrest (Begin 2007) | 263 | 15.6 | 0.3 | 0.2 | 2.9 | 0.086 | 1.4 | 1.0 | 2.0 | |
Chronic Lung Disease | 3,732 | 13.7 | 0.1 | 0.1 | 5.6 | 0.017 | 1.1 | 1.0 | 1.3 | |
Cerebrovascular Disease | 1,968 | 16.0 | 0.3 | 0.1 | 18.5 | 0.000 | 1.3 | 1.2 | 1.5 | |
Diabetes | 20,398 | 13.3 | 0.4 | 0.0 | 117.6 | 0.000 | 1.5 | 1.4 | 1.6 | |
Dialysis | 100 | 15.1 | -0.1 | 0.3 | 0.2 | 0.689 | 0.9 | 0.5 | 1.6 | |
Peripheral Vascular Disease | 4,154 | 12.8 | 0.0 | 0.1 | 0.5 | 0.468 | 1.0 | 0.9 | 1.2 | |
Renal Failure | 10,584 | 16.4 | 0.3 | 0.0 | 78.5 | 0.000 | 1.4 | 1.3 | 1.5 | |
Status of Procedure Urgent | 22,396 | 11.7 | 0.4 | 0.0 | 102.3 | 0.000 | 1.4 | 1.3 | 1.5 |
Notes:
If a patient had more than one intervention event of the same type on different dates during the index admission, only the intervention on the earliest date is included for fitting the model.
CL: Confidence Limit