The Toronto score for in-hospital mortality after percutaneous coronary interventions

Chowdhary, Saqib; Ivanov, Joan; Mackie, Karen; Seidelin, Peter H.; Džavík, Vladimir

doi:10.1016/j.ahj.2008.08.026

Cited by 55 publications

(53 citation statements)

References 21 publications

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“…25e27 Cardiovascular co-morbid conditions, such as diabetes, peripheral vascular disease, heart failure, and chronic renal failure, are important components of contemporary risk stratification scores for PCI, 25,26 whereas other co-morbid condition, such as chronic pulmonary disease, contributes to the clinical SYNTAX 28 and the National Cardiovascular Data Registry risk scores. 25 Contemporary PCI risk scores have not systematically included a weighting for co-morbidity burden, despite the important prognostic impact of measures of comorbidity, such as CCI in patients with cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study)

Mamas

Fath‐Ordoubadi

Danzi

et al. 2015

The American Journal of Cardiology

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Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study)

Mamas

Fath‐Ordoubadi

Danzi

et al. 2015

The American Journal of Cardiology

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“…Esta taxa é maior do que a 6/8 [32][33][34][35]. Na presente casuística, as altas incidências de complicações e mortalidade posterior podem ser justificadas pela inclusão apenas de pacientes internados, muitos por SCA, e pela gravidade dos pacientes atendidos, já que quase a metade possuía obstrução coronariana triarterial.…”

Section: Discussionunclassified

Caracterização do perfil e complicações intra-hospitalares dos pacientes submetidos ao cateterismo cardíaco em um hospital terciário

Braga

Silvano

Pereira

et al. 2017

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT Aims:To evaluate the profile of patients undergoing cardiac catheterization and in-hospital complications associated with the procedure. Methods: Cross-sectional analysis of baseline data of a retrospective cohort study conducted in a tertiary care hospital in southern Brazil between 2007 and 2013. The study included patients undergoing diagnostic or therapeutic cardiac catheterization. The data were extracted from electronic medical records using a standardized form and stored in a database for further analysis. Results: Out of 994 assessed patients, 584 (58.8%) were male. The mean age was 61.4 years. Hypertension was the most prevalent risk factor, followed by dyslipidemia and diabetes mellitus. Regarding clinical presentation, 550 (55.3%) patients had acute coronary syndrome, 402 (40.4%) had stable angina, and 42 (4.2%) were asymptomatic. Cineangiography was normal in 152 (15.3%) patients and abnormal in 842 (84.7%). Of these, 251 (29.8%) had single vessel disease, 190 (22.6%) had double vessel disease, and 401 (47.6%) had triple vessel disease. The overall incidence of complications was 15.6%, and 1% of the patients suffered some kind of major event (death during the procedure and neurological complications during their hospital stay). Other complications included acute kidney injury (1.4%) and local vascular complications (13.2%), mainly hematoma at the puncture site. Fifty (5%) patients died during the hospital stay, 46 (92%) of them from cardiac causes. Conclusions:The patients undergoing cardiac catheterization were predominantly male, with mean age of 61.4 years. The most frequent risk factors for cardiovascular disease included hypertension, dyslipidemia, and diabetes mellitus. Most of the patients had triple vessel disease. The main indication for the procedure was acute coronary syndrome. The overall incidence of complications was 15.6% with predominance of hematoma at the puncture site.

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“…The National Cardiovascular Data Registry (NCDR) score was determined in a large cohort and identified increased unadjusted in-hospital mortality for patients older than 70 years as compared to patients ≤70 years (2.25% vs. 0.76%) [43••]. Several risk scores, including the NCDR score, the Toronto PCI mortality score [45], the New York State percutaneous database [46], and the Mayo Clinic Risk Score [47], consistently report an increased mortality risk for patients older than 70 years and more importantly for patients older than 80 years. Peripheral artery disease, renal failure, and cerebrovascular disease are frequently encountered comorbidities in patients of advanced age and have additional predictive value in these scores.…”

Section: Risk Assessment Tools and Considerations For Revascularizatimentioning

confidence: 99%

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

McClurken

Rosenhek

Guy

et al. 2011

Curr Cardiovasc Risk Rep

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With the increased global burden of an aging population manifesting cardiovascular disease, the decision process for use of coronary revascularization options in older adults has gained attention. Assessment of physiologic status has greater bearing than chronologic age; items that have proven of particular merit in evaluating comorbidities as they relate to treatment prognosis for both PCI and CABG in older adults include Euro-SCORE and frailty scoring. Evaluation of neurocognitive function can uncover the presence and severity of all-cause dementia, which may be missed in simple medical history interaction. These data have significance when considering aggressive coronary artery disease treatments in this population for symptomatic and/or survival benefit, particularly when high priority is placed on quality of life and independent living post-treatment. Recovery after procedural intervention is slower and with increased morbidity in older adults. Older adults tend to have more complex coronary artery disease; for some, the risk/benefit of revascularization may be prohibitive. Proper selection by the cardiac team for appropriateness of treatment options for each patient's circumstances can result in excellent percutaneous coronary intervention and coronary artery bypass graft revascularization outcomes, even in the older adult.

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The Toronto score for in-hospital mortality after percutaneous coronary interventions

Cited by 55 publications

References 21 publications

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study)

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study)

Caracterização do perfil e complicações intra-hospitalares dos pacientes submetidos ao cateterismo cardíaco em um hospital terciário

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

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