California Cardiac Surgery Intervention Project

Summary of PCI with ACS Model based on California Inpatient Discharge Data, 2012-2013

Outcome:MACCE (Multiple Adverse Cardiovascular and Cerebral Events)
This outcome is determined based on the occurrence of 1 or more of the following events after the Index PCI or a Subsequent Connected Inpatient Admission:
  • Death during the PCI admission or during an inpatient re-admission connected to the index admission via acute transfer; disposition code '11' is used to identify in-hospital 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 connected to the PCI admission via acute transfer; ICD-9-CM codes used to identify MIs: 410.xx.
  • Post OP Stroke defined as stroke during the PCI admission that was not present at admission or stroke during an inpatient re-admission connected to the PCI admission via acute transfer; 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.
  • Re-Intervention defined as any cardiac surgery that occurred on or after the index PCI during the index PCI admission or a connected acute inpatient admission, or a PCI that occurred after the index PCI during the index PCI admission or a connected un-scheduled acute inpatient admission. Any procedure in the range 35.xx-38.xx that was performed using ECC (ICD-9-CM procedure code 39.61) or off-pump CABG procedure (36.1x) is considered a re-intervention. Furthermore, any PCI (36.01, 36.02, 36.05, 36.06, 36.09, 00.66) that is performed after the index PCI either during the index admission or a subsequent connected un-scheduled acute inpatient admission is considered a re-intervention.
All events are weighted equally.
Model Statistics:
Number of Observations: 50,415
% of Observations with Outcome: 10.1%
C-statistic: 0.689Pseudo-R2: 10.7Hosmer-Lemeshow P-Value: 0.160
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 -2.9 0.12955.8 0.000
Age at Admission18-<50 7,089 7.3 -0.3 0.1 20.2 0.000 0.8 0.7 0.9
50-<55 4,559 7.9 -0.2 0.1 10.3 0.001 0.8 0.7 0.9
55-<60 6,897 8.9 -0.1 0.1 4.7 0.030 0.9 0.8 1.0
60-<65 7,294 10.0 -0.0 0.1 0.3 0.598 1.0 0.9 1.1
65-<70 6,842 10.3Reference
70-<75 5,503 10.8 0.0 0.1 0.0 0.892 1.0 0.9 1.1
75-<80 4,734 11.7 0.1 0.1 2.9 0.091 1.1 1.0 1.3
80 or older 7,497 13.4 0.2 0.1 16.8 0.000 1.3 1.1 1.4
Patient SexMale 35,546 9.9Reference
Female 14,869 10.4 -0.1 0.0 3.8 0.053 0.9 0.9 1.0
RaceOther race 7,380 11.0 0.1 0.0 3.2 0.072 1.1 1.0 1.2
White 35,193 10.0Reference
Black 2,914 7.8 -0.2 0.1 7.4 0.007 0.8 0.7 0.9
Asian/Pacific Islander 4,928 10.5 0.0 0.1 0.6 0.456 1.0 0.9 1.2
EthnicityNon-Hispanic 40,256 9.7Reference
Hispanic 10,159 11.4 0.2 0.0 13.6 0.000 1.2 1.1 1.3
Acute MI Present at Scheduled Admission 4,632 6.3 -0.2 0.1 7.1 0.008 0.8 0.7 1.0
Atrial Fibrillation and Flutter 4,989 14.2 0.1 0.0 6.5 0.011 1.1 1.0 1.2
Cardiogenic Shock 2,859 38.8 1.7 0.01524.3 0.000 5.7 5.2 6.2
Cardiomyopathy 2,092 14.6 0.2 0.1 6.8 0.009 1.2 1.0 1.4
Heart Failure 10,256 15.4 0.3 0.0 55.7 0.000 1.3 1.2 1.4
HX Sudden Cardiac Arrest (Begin 2007) 287 16.9 0.3 0.2 3.2 0.074 1.4 1.0 1.9
Chronic Lung Disease 4,532 12.8 0.2 0.1 8.8 0.003 1.2 1.1 1.3
Cerebrovascular Disease 1,866 15.7 0.4 0.1 35.5 0.000 1.5 1.3 1.7
Diabetes 18,283 11.5 0.1 0.0 19.0 0.000 1.2 1.1 1.2
Dialysis 636 10.3 -0.2 0.1 1.7 0.196 0.8 0.6 1.1
Peripheral Vascular Disease 5,062 12.2 0.0 0.1 0.2 0.680 1.0 0.9 1.1
Renal Failure 8,650 13.7 0.2 0.0 33.8 0.000 1.3 1.2 1.4
Status of Procedure Urgent 23,745 12.9 0.6 0.0 279.7 0.000 1.8 1.7 1.9
Notes:
If a patient had more than one surgery event of the same type on different dates during the index admission, only the surgery on the earliest date is included for fitting the model.
CL: Confidence Limit

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