Validação externa de escore de predição de morte hospitalar em pacientes submetidos a intervenção coronária percutânea

Abstract

Estimating percutaneous coronary intervention (PCI) mortality risk by a clinical prediction model is imperative to help physicians, patients and family members to make informed clinical decisions and to increase participation in the consent process, reducing anxiety and improving quality of care. At a healthcare system level, prediction risk scores are essential to measure and benchmark performance. We sought to assess the accuracy of the simple, contemporary and well-designed Toronto PCI mortality risk score in a Brazilian cohort (ICP-BR registry).Between February 11, 2009 and January 25, 2013, a cohort from the ICP-BR registry of 4,806 patients submitted to PCI in eight tertiary referral medical centers were included in the analysis. This population was compared to 10,694 patients from the derivation data of the Toronto study. Death occurred in 2.6% of patients in the ICP-BR registry and in 1.3% in the Toronto study. The median age was 64 and 63 years, 23.8 and 32.8% were female and diabetes was present in 28.6 and 32.3%, respectively. To assess the performance of the score, the model was updated to adjust the differences between the two datasets. Thus, through recalibration of intercept and slope (AUC= 0.8790; Hosmer-Lemeshow p= 0.3132), we demonstrated that the Toronto PCI in-hospital mortality risk score has a good performance and discrimination in Brazilian population.