A PROGNOSTIC COMPUTER-MODEL TO PREDICT INDIVIDUAL OUTCOME IN INTERVENTIONAL CARDIOLOGY

It is not yet possible to predict an individual's outcome from percuta neous transluminal coronary angioplasty or alternative/adjunctive coro nary interventional techniques. The purpose of the INTERVENT project i s to redefine complications associated with coronary interventions, to set up a prognostic computer model to predict individual outcome and to compare the results to those of conventional statistical techniques . 2500 data items were analysed in 455 consecutive patients (mean age: 61.1+/-8.3 years; range 33-84 years 80.4% male, 16.7% unstable angina , 5.1%/10.1% acute/subacute myocardial infarction) undergoing coronary interventions at three university centres. In-lab/out-of-lab complica tion rates were 0.4%/0.9% (death), 1.8%/0.2% (abrupt vessel closure wi th myocardial infarction) and 5.5%/4.0% (haemodynamic complications). Computer algorithms derived by applying techniques from artificial int elligence were able (1) to reduce the set of possible relevant risk fa ctors from 2500 to about 40, (2) to predict individual risk with an ac curacy of >95% and (3) to explain the structural relationship between outcome and risk factors. Patient data from two centres were used to c onstruct and test the algorithm. Data from a third centre were used to evaluate the algorithm. The most important predictors were acute myoc ardial infarction, heart failure (NYHA class >II), unstable angina, co mplex lesions, high low density lipoprotein cholesterol and duration o f coronary heart disease. Neither age nor gender impaired the percutan eous transluminal coronary angioplasty results in acute ischaemic synd romes; however, for stable angina, procedural risk increased with age. There was little risk from primary percutaneous transluminal coronary angioplasty in acute myocardial infarction in patients with NYHA hear t failure classes I-II; however, the risk was high for patients in NYH A classes >II, either with or without additional thrombolysis. Alterna tive/adjunctive intervention techniques were no predictors for in-lab- , but were predictors for post-procedural complications.