OBJECTIVES: To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser's comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. METHODS: This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. RESULTS: Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: +/-10.2) and 64.8% of the population was male. Among them, 1,598 (2.6%) had died in hospital. While the predictive ability of the Elixhauser s comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. CONCLUSIONS: In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.
Adult ; *Angioplasty, Transluminal, Percutaneous Coronary ; *Comorbidity ; Female ; Hospital Mortality ; Humans ; Insurance Claim Review ; Male ; Middle Aged ; Retrospective Studies

The impact of treatment delays to reperfusion on patient mortality after primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) is controversial. We analyzed 5,069 patients included in the Korea Acute Myocardial Infarction Registry (KAMIR) between November 2005 and January 2007. We selected 1,416 patients who presented within 12 hr of symptom onset and who were treated with primary PCI. The overall mortality at one month was 4.4%. The medians of door-to-balloon time, symptom onset-to-balloon time, and symptom onset-to-door time were 90 (interquartile range, 65-136), 274 (185-442), and 163 min (90-285), respectively. One-month mortality was not increased significantly with any increasing delay in door-to-balloon time (4.3% for < or =90 min, 4.4% for >90 min; p=0.94), symptom onset-to-balloon time (3.9% for < or =240 min, 4.8% for >240 min; p=0.41), and symptom onset-to-door time (3.3% for < or =120 min, 5.0% for >120 min; p=0.13). These time variables had no impact on one-month mortality in any subgroup. Thus, this first nationwide registry data in Korea showed a good result of primary PCI, and the patient prognosis may not depend on the initial treatment delay using the current protocols.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*mortality ; Cohort Studies ; Female ; Humans ; Kaplan-Meiers Estimate ; Korea/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/*mortality/*therapy ; Predictive Value of Tests ; Registries/statistics & numerical data ; Time Factors

BACKGROUND: We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI) and long-term survival rate after primary or rescue PCI in patients with acute myocardial infarction (AMI) according to the level of the C-Reactive Protein (CRP) on admission. METHODS: Two hundred and eight consecutive patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9+/-9.3 years, male 74.4%) with a normal CRP (< 1.0 mg/dL, mean value=0.43+/-0.14 mg/dL) on admission and Group II (n=122, 59.1+/-10.4 years, male 83.6%) with an elevated CRP (> or==1.0 mg/dL, mean value=3.50+/-0.93 mg/dL) on admission. RESULTS: There were no significant differences in the baseline characteristics noted between the two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs. Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings did not differ between the two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow grade improved after PCI in both groups. The primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates for Group I were 97.7%, 97.7% and 96.5%, and those for Group II were 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). CONCLUSION: A high incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with an elevated CRP.
Age Factors ; Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*methods/mortality ; Biological Markers/analysis ; C-Reactive Protein/analysis/*metabolism ; Chi-Square Distribution ; Cohort Studies ; Coronary Angiography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction/*mortality/radiography/*therapy ; Probability ; Prognosis ; Prospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Factors ; Survival Analysis ; Time Factors ; Treatment Outcome