Key result
Adding bleeding or myocardial infarction to baseline clinical variables did not significantly improve risk discrimination for 1-year mortality (delta C-statistic 0.024; 95% CI -0.014 to 0.065; P=0.200 for bleeding).
Why the study?
It remained unknown whether bleeding and myocardial infarction improve the performance of risk prediction models for mortality in patients with acute coronary syndromes treated with percutaneous coronary intervention.
Does the inclusion of bleeding and myocardial infarction improve the performance of risk prediction models for 1-year mortality in patients with ACS treated with PCI?
Cohort (n=3,377)
Does the inclusion of bleeding and myocardial infarction improve the performance of risk prediction models for 1-year mortality in patients with ACS treated with PCI?
Effect estimate: delta C-statistic 0.024 (95% CI -0.014 to 0.065)
p-value: p=0.200
In patients with ACS undergoing PCI, adding post-procedural bleeding or MI to baseline clinical variables does not significantly improve the discrimination of risk prediction models for 1-year mortality.
Does not support adding bleeding or MI to 1-year mortality models in ACS-PCI; leaves open their value for other endpoints or populations.
BACKGROUND: Whether bleeding and myocardial infarction (MI) improve the performance of risk prediction models for mortality in patients with acute coronary syndromes (ACS) treated with percutaneous coronary intervention (PCI) remains unknown. METHODS: This study included 3377 patients with ACS who underwent PCI in the setting of the ISAR-REACT 5 trial. Patients with bleeding, MI or those dying at 1 year after PCI were characterized in terms of baseline characteristics, risk estimates and C-statistic of the risk prediction models for these outcomes. RESULTS: Major bleeding (Bleeding Academic Research Consortium types 3-5), MI and mortality occurred in 195 patients (5.8%), 143 patients (4.3%) and 143 patients (4.3%), respectively. After adjustment, bleeding [hazard ratio = 5.08; 95% confidence interval (CI), 3.03-8.53; P < 0.001] and MI [hazard ratio = 5.90; 95% CI, (3.00-11.65); P < 0.001) remained independently associated with the risk for 1-year mortality. The C-statistic (with 95% CI) of the model for bleeding, MI and mortality was, 0.755 (0.722-0.786), 0.752 (0.717-0.789) and 0.868 (0.837-0.896), respectively. The inclusion of bleeding [C-statistic: 0.892 (0.867-0.913); delta C-statistic 0.024 (-0.014 to 0.065); P = 0.200] or MI [C-statistic: 0.878 (0.851-0.903); delta C-statistic 0.011 (-0.030 to 0.053); P = 0.635] in the risk prediction models for mortality alongside baseline demographical and clinical variables did not improve prediction for mortality. CONCLUSIONS: In patients with ACS treated with PCI, mortality is the most accurately predicted outcome. Bleeding and MI did not improve risk discrimination for mortality when added in the risk prediction models for mortality suggesting that these outcomes do not provide incremental prognostic information on top of baseline demographical and clinical data.
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A 2022 study conducted a cohort in Acute coronary syndromes (n=3,377). Bleeding and myocardial infarction vs. Baseline demographical and clinical variables alone was evaluated on Improvement in risk prediction for 1-year mortality (delta C-statistic 0.024, 95% CI -0.014 to 0.065, p=0.200). Adding bleeding or myocardial infarction to baseline clinical variables did not significantly improve risk discrimination for 1-year mortality (delta C-statistic 0.024; 95% CI -0.014 to 0.065; P=0.200 for bleeding).
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