PERCUTANEOUS
CORONARY
INTERVENTIONS
(Angioplasty)
in
New York State
1995-1997
New York State Department of Health
July 2001
Members of the New York State
State Cardiac Advisory Committee
Chair
Vice Chair
Kenneth I. Shine, M.D.
Institute of Medicine
National Academy of Sciences
Washington, DC
O. Wayne Isom, M.D.
Professor and Chairman
Department of Cardiothoracic Surgery and
Surgeon-in-Chief
Weill-Cornell Medical Center
New York, NY
Members
Djavad T. Arani, M.D.
Clinical Associate Professor of Medicine
SUNY at Buffalo School of Medicine
The Buffalo General Hospital, Buffalo, NY
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital, Albany, NY
Luther Clark, M.D.
Chief, Division of Cardiovascular Medicine
University Hospital of Brooklyn
Brooklyn, NY
Alfred T. Culliford, M.D.
Professor of Clinical Surgery
NYU Medical Center
New York, NY
Jeffrey P. Gold, M.D.
Chairman, Cardiac & Thoracic Surgery
Montefiore Medical Center
Bronx, NY
Alan Hartman, M.D.
Department of Cardiovascular Surgery
Winthrop University Hospital, Mineola, NY
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center, Durham, NC
Stanley Katz, M.D.
Chief, Division of Cardiology
North Shore - LIJ Health System
Manhasset, NY
Ben D. McCallister, M.D.
Endowed Chair and Director
Cardiovascular Research
Mid America Heart Institute
Saint Luke's Hospital
Kansas City, MO
Barbara J. McNeil, M.D., Ph.D.
Head, Department of Health Care Policy
Harvard Medical School, Boston, MA
Alvin Mushlin, M.D., Sc.M.
Professor and Chair
Department of Public Health
Weill Medical College of Cornell University
New York, NY
Jan M. Quaegebeur, M.D., Ph.D.
Department of Surgery
Columbia-Presbyterian Medical Center
New York, NY
Eric A. Rose, M.D.
Professor, Chair and Surgeon-in-Chief,
Department of Surgery
Columbia-Presbyterian Medical Center
New York, NY
Thomas J. Ryan, M.D.
Professor of Medicine
Boston University Medical Center
Boston, MA
Rev. Robert S. Smith
Director, Sophia Center
Diocese of Rockville Centre
Huntington, NY
Valavanur A. Subramanian, M.D.
Director, Department of Surgery
Lenox Hill Hospital, New York, NY
Gary Walford, M.D.
Director, Cardiac Catheterization Laboratory
St. Joseph’s Hospital, Syracuse, NY
Roberta Williams, M.D.
Vice President of Pediatrics and
Academic Affairs
USC - Children’s Hospital
Los Angeles, CA
PCI Reporting System Analysis Workgroup
Members
Ben D. McCallister, M.D. (Chair)
Endowed Chair and Director
Cardiovascular Research
Mid America Heart Institute
Djavad T. Arani, M.D.
Clinical Associate Professor of Medicine
SUNY at Buffalo School of Medicine
The Buffalo General Hospital
Luther Clark, M.D.
Chief, Division of Cardiovascular Medicine
University Hospital of Brooklyn
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center
Staff & Consultants to PCI Analysis Workgroup
Donna R. Doran
Administrator, Cardiac Services Program
New York State Department of Health
Rhonda J. O’Brien
Cardiac Database Manager
Cardiac Services Program
New York State Department of Health
Casey S. Roark
Cardiac Databases Coordinator
Research Foundation of SUNY
Stanley Katz, M.D.
Chief, Division of Cardiology
North Shore – LIJ Health System
Barbara J. McNeil, M.D., Ph. D.
Head, Department of Health Care Policy
Harvard Medical School
Thomas J. Ryan, M.D
Professor of Medicine
Boston University Medical Center
Gary Walford, M.D.
Director, Cardiac Catheterization Laboratory
St. Joseph’s Hospital
Edward Hannan, Ph.D.
Professor & Chair
Department of Health Policy,
Management & Behavior
SUNY School of Public Health
Michael Racz
Research Scientist
Department of Health Policy,
Management & Behavior
SUNY School of Public Health
TABLE OF CONTENTS
MESSAGE FROM COMMISSIONER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
HEALTH DEPARTMENT PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
PATIENT POPULATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
RISK ADJUSTMENT FOR ASSESSING PROVIDER PERFORMANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Data Collection, Data Validation and Identifying In-Hospital Deaths . . . . . . . . . . . . . . . . . . . . . . . . . .4
Assessing Patient Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Predicting Patient Mortality Rates for Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Computing the Risk-Adjusted Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Interpreting the Risk-Adjusted Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
How this Contributes to Quality Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
1997 HOSPITAL RISK–ADJUSTED MORTALITY FOR PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
1995 – 1997 HOSPITAL DATA FOR PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Table 1
Hospital Observed, Expected and Risk-Adjusted Mortality
Rates (RAMR) for PCI in New York State, 1997 Discharges . . . . . . . . . . . . . . . . . . . . . . . . .8
Table 2
Hospital Observed, and Risk-Adjusted Mortality
Rates (RAMR) for PCI in New York State, 1995 - 1997 Discharges . . . . . . . . . . . . . . . . . . . .9
1995 - 1997 HOSPITAL AND CARDIOLOGIST DATA FOR PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Table 3
Cardiologist Observed, Expected and Risk-Adjusted Mortality
Rates (RAMR) for PCI in New York State, 1995 - 1997 Discharges . . . . . . . . . . . . . . . . . . . 10
Table 4
Summary Information for Cardiologists Practicing at More
Than One Hospital, 1995 - 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
CRITERIA USED IN REPORTING SIGNIFICANT RISK FACTORS (1997) . . . . . . . . . . . . . . . . . . . . . . . . 24
MEDICAL TERMINOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
APPENDIX 1 1997 Risk Factors for PCI In-Hospital Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
APPENDIX 2 1997 Risk Factors For In-Hospital Mortality for Non-Emergency PCI . . . . . . . . . . . . . . . . . 30
APPENDIX 3 1995 - 1997 Risk Factors for PCI In-Hospital Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
APPENDIX 4 1995 - 1997 Risk Factors for In-Hospital Mortality for Non-Emergency PCI . . . . . . . . . . . . 34
APPENDIX 5 1995 - 1997 Risk Factors for In-Hospital Mortality for Emergency PCI . . . . . . . . . . . . . . . . 35
MESSAGE FROM COMMISSIONER
I am pleased to provide the information contained in this booklet for use by health care providers,
patients and families of patients who are considering treatment options for cardiovascular disease. The
report provides data on risk factors associated with in-hospital mortality following percutaneous coronary
intervention (also known as angioplasty) and lists hospital and physician-specific mortality rates that have
been risk-adjusted to account for differences in patient severity of illness.
The Percutaneous Coronary Interventions (PCI) Reporting System (the data set upon which these analyses
are based) represents the largest collection of data available in which all patients undergoing PCI have been
reported. Hospitals and doctors involved in cardiac care have worked cooperatively with the Department
of Health and the Cardiac Advisory Committee to compile accurate and meaningful data that can and have
been used to enhance quality of care. As part of that process, we have expanded our PCI analyses this year
to include more comprehensive information on non-emergency and emergency cases. In addition, this is
the first year we have provided physician specific analysis of outcomes.
I encourage doctors to discuss this information with their patients and colleagues as they develop treatment
plans. While these statistics are an important tool in making informed health care choices, doctors and
patients must make individual treatment plans together; after careful consideration of all pertinent factors.
It is also important to keep in mind that the information in this booklet does not include data after 1997.
Important changes may have taken place in some hospitals since that time.
I would also ask that patients and physicians alike give careful consideration to the importance of healthy
lifestyles for all those affected by heart disease. Controllable risk factors that contribute to a higher
likelihood of developing coronary artery disease are high cholesterol levels, cigarette smoking, high blood
pressure, obesity and lack of exercise. Limiting these risk factors will continue to be important in
minimizing the occurrence of new blockages.
I extend my appreciation to the providers in this state and to the Cardiac Advisory Committee for their
efforts in developing and refining this remarkable system. The Department of Health will continue to
work in partnership with hospitals and physicians to ensure high quality of care for patients with heart
disease. We look forward to providing reports such as this and the Coronary Artery Bypass Report on
an annual basis and to the continuing high quality of care available from our New York State health
care providers.
1
2
INTRODUCTION
Heart disease is, by far, the leading cause of death in New York State, and the most common form of
heart disease is atherosclerotic coronary artery disease. Various treatments are recommended for patients
with coronary artery disease. For some people, changes in lifestyle, such as dietary changes, not smoking
and regular exercise can result in great improvements in health. In other cases, medication prescribed for
high blood pressure or other conditions can make a significant difference.
Sometimes, however, an interventional procedure is recommended. The two most common procedures
performed on patients with coronary artery disease are percutaneous coronary intervention (PCI), also
known or percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft
surgery (CABG).
During a PCI procedure, a catheter is threaded up to the site of the blockage in a coronary artery. In
conjunction with the catheter, devices are used to reopen the blockage. In some cases, PCI is used as
an emergency treatment for patients who are experiencing a heart attack or who may be in shock. Most
cases, however, are not done on an emergency basis.
Those who have a PCI procedure are not cured of coronary artery disease; the disease can still occur in
the treated blood vessels or other coronary arteries. In order to minimize new blockages, patients should
continue to reduce their risk factors for heart disease.
The analyses contained in this report are based on the information collected on each of the 76,877
patients who underwent PCI and were discharged between January 1, 1995 and December 31, 1997. The
number of PCI cases per year has increased during that period from 21,707 in 1995 to 29,516 in 1997.
Analyses of risk adjusted mortality rates and associated risk factors are provided for 1997 and for the
three-year period from 1995 through 1997. Analysis of all cases, non-emergency cases (which represent
the majority of procedures) and emergency cases are included.
HEALTH DEPARTMENT PROGRAM
The New York State Department of Health has been studying the effects of patient and treatment
characteristics on outcomes for patients with heart disease for several years. Detailed statistical analyses
of the information received from the study have been conducted under the guidance of the New York
State Cardiac Advisory Committee, a group of independent practicing cardiac surgeons, cardiologists, and
other professionals in related fields.
The results have been used to create a cardiac profile system that assesses the performance of hospitals
and doctors over time, taking into account the severity of individual patients’ pre–operative conditions.
Coronary artery bypass surgery results have been assessed since 1989; PCI results were released in
1996 for the first time.
Designed to improve health in people with heart disease, this program is aimed at:
•
understanding the health risks of patients that adversely affect how they will fare during
and after PCI;
•
improving the results of different treatments of heart disease;
•
improving cardiac care; and
•
providing information to help patients make better decisions about their own care.
PATIENT POPULATION
All adult patients undergoing PCI in New York State hospitals who were discharged during 1997 are
included in the one-year results presented in this report. Similarly, all patients undergoing PCI who
were discharged between January 1, 1995 and December 31, 1997 are included in the three-year results.
Observed and risk-adjusted mortality rates are reported for patients undergoing PCI in each of the 33
New York State hospitals with approval to perform the procedure.
During the period covered by this report, an international study known as the SHOCK trial (“SHould
we emergently revasularize Occluded Coronaries for cardiogenic shocK”) was undertaken to evaluate the
3
efficacy of PCI and other treatments for patients in severe shock. The principal investigator of this trial
requested that patients participating in the trial be excluded from the analyses of outcomes in the New York
State System. This request was granted based on a 1995 Cardiac Advisory Committee recommendation, with
the understanding that data on the number of cases and deaths excluded would be provided.
In 1997, 8 SHOCK trial cases (including 2 deaths) were excluded from the analysis based on this exception.
For the period 1995 – 1997, 17 cases (including 7 deaths) were excluded.
RISK ADJUSTMENT FOR ASSESSING PROVIDER PERFORMANCE
Hospital or physician performance is an important factor that directly relates to patient outcomes. Whether
patients recover quickly, experience complications, or die following a procedure is in part a result of the
kind of medical care they receive. It is difficult, however, to compare outcomes among hospitals when
assessing performance, because different hospitals treat different types of patients. Hospitals with sicker
patients may have higher rates of complications and death than other hospitals in the state. The following
describes how the New York State Department of Health adjusts for patient risk in assessing outcomes
of care in different hospitals.
Data Collection, Data Validation and Identifying In-Hospital Deaths
As part of the risk-adjustment process, hospitals in New York State at which PCI is performed provide
information to the Department of Health for each patient undergoing those procedures. Data concerning
patients’ demographic and clinical characteristics are collected by hospitals’ cardiac catheterization
laboratories. Approximately 40 of these characteristics (or risk factors) are collected for each patient. Along
with information about the hospital, physician, and the patient’s status at discharge, these data are entered
into a computer, and sent to the Department of Health for analysis.
Data are verified through review of unusual reporting frequencies, cross-matching of PCI data with other
Department of Health databases and a review of medical records for a selected sample of cases. These
activities are extremely helpful in ensuring consistent interpretation of data elements across hospitals.
The analysis bases mortality on deaths occurring during the same hospital stay in which a patient underwent
PCI. In this report, an in-hospital death is defined as a patient who died subsequent to PCI during the same
acute care admission or was discharged to hospice care.
Assessing Patient Risk
Each person who develops coronary artery disease has a unique health history. A cardiac profile system
has been developed to evaluate the risk of treatment for each individual patient based on his or her history,
weighing the important health facts for that person based on the experiences of thousands of patients
who have undergone the same procedures in recent years. All important risk factors for each patient are
combined to create his or her risk profile.
An 80-year-old patient with a heart attack in the past six hours, for example, has a very different risk profile
than a 40-year-old who has never suffered a heart attack.
The statistical analyses conducted by the New York State Department of Health consist of determining
which of the risk factors collected are significantly related to in-hospital death, and determining how to
weight the significant risk factors to predict the chance each patient will have of dying in the hospital
given his or her specific characteristics.
Predicting Patient Mortality Rates for Providers
The statistical methods used to predict mortality on the basis of the significant risk factors are tested to
determine if they are sufficiently accurate in predicting mortality for patients who are extremely ill prior to
undergoing the procedure as well as for patients who are relatively healthy. These tests have confirmed
that the models are reasonably accurate in predicting how patients of all different risk levels will fare
when undergoing PCI.
4
The mortality rate for each hospital and cardiologist is also predicted using the statistical model. This is
accomplished by adding the predicted probabilities of death for each of the provider’s patients and dividing
by the number of patients. The resulting rate is an estimate of what the provider’s mortality rate would
have been if the hospital’s performance was identical to the state performance. The percentage is called
the predicted or expected mortality rate (EMR). A hospital's expected mortality rate is contrasted with
its observed mortality rate (OMR), which is the number of PCI inpatients who died divided by the total
number of PCI inpatients.
Computing the Risk-Adjusted Rate
The risk-adjusted mortality rate (RAMR) represents the best estimate, based on the associated statistical
model, of what the provider’s mortality rate would have been if the provider had a mix of patients
identical to the statewide mix. Thus, the risk-adjusted mortality rate has, to the extent possible, ironed out
differences among providers in patient severity of illness, since it arrives at a mortality rate for each provider
based on an identical group of patients.
To get the risk-adjusted mortality rate, the observed mortality rate is first divided by the provider’s expected
mortality rate. If the resulting ratio is larger than one, the provider has a higher mortality rate than expected
on the basis of its patient mix; if it is smaller than one, the provider has a lower mortality rate than expected
from its patient mix. The ratio is then multiplied by the overall statewide rate (0.90 for all cases in 1997)
to obtain the provider’s risk-adjusted rate.
Interpreting the Risk-Adjusted Mortality Rate
If the risk-adjusted mortality rate is lower than the statewide mortality rate, the hospital has a better
performance than the state as a whole; if the risk-adjusted mortality rate is higher than the statewide
mortality rate, the hospital has a worse performance than the state as a whole.
The risk-adjusted mortality rate is used in this report as a measure of quality of care provided by hospitals
and cardiologists. However, there are reasons that a provider’s risk-adjusted rate may not be indicative
of its true quality.
For example, extreme outcome rates may occur due to chance alone. This is particularly true for lowvolume providers, for whom very high or very low rates are more likely to occur than for high-volume
providers. Another attempt to prevent misinterpretation of differences caused by chance variation is the use
of expected ranges (confidence intervals) in the reported results.
Differences in hospital coding of risk factors could be an additional reason that a hospital’s risk-adjusted
rate may not be reflective of quality of care. The Department of Health monitors the quality of coded
data by reviewing patients’ medical records to ascertain the presence of key risk factors. When significant
coding problems have been discovered, hospitals have been required to recode these data and have been
subject to subsequent monitoring.
Some commentators have suggested that patient severity of illness may not be accurately estimated because
some risk factors are not included in the data system, and this could lead to misleading risk-adjusted rates.
This is not likely because the New York State data system has been reviewed by practicing physicians in the
field and updated continually. It now contains virtually every risk factor that has ever been demonstrated to
be related to patient mortality in national and international studies.
How This Contributes to Quality Improvement
The goal of the Department of Health and the Cardiac Advisory Committee is to improve the quality of
care in relation to coronary artery bypass graft surgery and angioplasty in New York State. Providing the
hospitals, cardiac surgeons (who perform CABG surgery), and cardiologists (who perform PCI) in New York
State with data about their own outcomes for these procedures allows them to examine the quality of their
own care, and to identify opportunities to improve that care.
5
The data collected and analyzed in this program are also given to the Cardiac Advisory Committee, who
assist with interpretation and advise the Department of Health regarding which hospitals and physicians
may need special attention. Committee members have also conducted site visits to particular hospitals, and
have recommended that some hospitals obtain the expertise of outside consultants to design improvements
for their programs.
1997 HOSPITAL RISK-ADJUSTED MORTALITY FOR PCI
Table 1 presents the 1997 PCI mortality results for the 33 hospitals performing PCI in New York in 1997.
The table contains, for each hospital, the number of PCIs resulting in 1997 discharges, the number of
in-hospital deaths, the observed mortality rate, the expected mortality rate based on the statistical model
presented in Appendix 1, the risk-adjusted mortality rate, and a 95% confidence interval for the risk-adjusted
rate. Also, it contains each hospital’s volume of cases and risk-adjusted mortality rate for non-emergency
patients. Emergency patients are defined to be patients in shock, a state of hemodynamic instability
(very low blood pressure), requiring cardiopulmonary resuscitation immediately prior to the procedure, or
patients who experienced a heart attack within 24 hours prior to undergoing PCI. The hospital risk-adjusted
rates for non-emergency PCI patients are provided because many studies are confined to this group of
patients, and because these patients comprise the majority of all PCI patients (91.8% in 1997).
The overall mortality rate for the 29,516 PCIs performed at the 33 hospitals was 0.90%. Observed mortality
rates ranged from 0.00% to 2.06%. The range in expected mortality rates, which measure patient severity of
illness, was between 0.53% and 1.66%. The risk-adjusted rates, which measure hospital performance, range
from 0.00% to 2.15%. Based on confidence intervals for risk-adjusted rates, two hospitals (Weill Cornell-NYP
and Montefiore-Einstein) had a significantly higher risk-adjusted mortality rate than the statewide rate. No
hospitals had a significantly lower risk-adjusted mortality rate than the statewide rate.
The last column of Table 1 presents the hospital risk-adjusted mortality rates for non-emergency cases only
(based on the statistical model presented in Appendix 2.) As presented in the last row, the statewide
mortality rate for non-emergency cases is 0.51%. The range of risk-adjusted rates was from 0.00% to 1.46%.
One hospital, Montefiore-Einstein, had a significantly higher risk-adjusted mortality rate than the statewide
rate. No hospitals had a significantly lower risk-adjusted mortality rate than the statewide rate.
1995-1997 HOSPITAL DATA FOR PCI
Table 2 provides the number of PCIs, the observed mortality rate, and the risk-adjusted mortality rate for
1995-97 for each of three types of PCI patients in the 33 hospitals performing PCI during the time period.
The three types of patients are all patients, non-emergency patients, and emergency patients [(patients in
shock, a state of hemodynamic instability (very low blood pressure), cardiopulmonary resuscitation (CPR)
administered immediately prior to the procedure or patients who experienced a heart attack within 24 hours
prior to undergoing PCI)]. The statistical models that are the basis for all patients, non-emergency patients,
and emergency patients in 1995-1997 are presented in Appendices 3-5, respectively.
As indicated in Table 2, the three-year observed mortality rates for all PCI patients ranged from 0.15%
to 1.93%, and the risk-adjusted mortality rates ranged from 0.30% to 1.84%. Four hospitals (Arnot-Ogden
Memorial, Montefiore-Einstein, St. Vincent’s, and University Hospital at Stony Brook) had risk-adjusted
mortality rates that were significantly higher than the statewide rate, and three hospitals (Buffalo General,
Maimonides, and St. Francis) had risk-adjusted mortality rates that were significantly lower than the
statewide rate. It should be noted that hospitals are more likely to have results that show a statistically
significant difference from the statewide rate when three years of data are used than when one year of data
is used because the three-year volumes are higher.
6
Table 2 also presents the 3-year risk adjusted mortality rates for non-emergency cases based on the model
in Appendex 4. Non-emergency cases comprise 91.9% of cases for the period 1995-1997. The statewide
mortality rate for the 70,664 non-emergency cases during the 3-year period was 0.49%. Observed mortality
rates for this group of patients ranged from 0 - 0.98% and the risk-adjusted mortality rates ranged from
0-1.29%. Four hospitals (Arnot-Ogden, Montefiore-Einstein, University Hospital of Stony Brook and WeillCornell-NYP) had risk-adjusted mortality rates that were significantly higher than the statewide average.
Three hospitals (Buffalo General, Montefiore-Moses and St. Francis) had risk-adjusted mortality rates
significantly below the statewide rate for non-emergency cases.
The last three columns in Table 2 present data on emergency cases based on the model in Appendix 5.
Emergency cases represented 8.1% of cases for the period 1995-1997. The statewide mortality rate for the
6,213 emergency PCI cases during the 3-year period was 5.87%. Observed mortality rates for this group
ranged from 2.60% to 28.57% and the risk-adjusted mortality rates ranged from 3.31% - 18.05%. One hospital
(St. Francis), had a risk adjusted mortality rate that was significantly below the statewide average and one
hospital (St. Vincent's Medical Center) had a risk adjusted mortality rate that was significantly above the
statewide average for emergency cases.
Definitions of key terms are as follows:
The observed mortality rate (OMR) is the observed number of deaths divided by the number of patients.
The expected mortality rate (EMR) is the sum of the predicted probabilities of death for all patients
divided by the total number of patients.
The risk-adjusted mortality rate (RAMR) is the best estimate, based on the statistical model, of what the
provider’s mortality rate would have been if the provider had a mix of patients similar to the statewide
mix. It is obtained by first dividing the observed mortality rate by the expected mortality rate, and then
multiplying that quotient by the statewide mortality rate (0.90% for all PCI patients in 1997).
Confidence intervals indicate which hospitals had significantly more or fewer deaths than expected given
the risk factors of their patients. Hospitals with significantly higher rates than expected after adjusting for
risk are those with confidence intervals entirely above the statewide rate. Hospitals with significantly lower
rates than expected given the severity of illness of their patients before the PCI have confidence intervals
entirely below the statewide rate.
7
Table 1 Hospital Observed, Expected, and Risk-Adjusted Mortality Rates (RAMR) for PCI in New York State, 1997 Discharges
(Listed Alphabetically by Hospital)
All Cases
Non-Emergency
Hospital
Cases
Deaths
OMR
EMR
RAMR
Albany Medical Center
Arnot-Ogden
Bellevue
Beth Israel
Buffalo General
Columbia Presbyterian-NYP
Crouse Hospital
Ellis Hospital
Erie County
LIJ Medical Center
Lenox Hill
Maimonides
Millard Fillmore
Montefiore - Einstein
Montefiore - Moses
Mount Sinai
NYU Hospitals Center
New York Hospital - Queens
North Shore
Rochester General
St. Francis
St. Josephs
St. Lukes-Roosevelt
St. Peters
St. Vincents
Strong Memorial
United Health Services
Univ. Hosp. - Stony Brook
Univ. Hosp. - Upstate
Univ. Hosp. of Brooklyn
Weill Cornell-NYP
Westchester Medical Center
Winthrop Univ. Hosp.
1061
325
168
783
810
453
660
559
152
587
1742
1255
725
535
405
1447
690
751
2342
1839
2227
1523
489
932
1142
456
802
797
160
300
992
1479
928
8
4
1
6
1
5
6
6
1
5
19
10
8
11
1
8
8
9
20
14
10
9
3
9
13
6
12
13
1
0
15
21
4
0.75
1.23
0.60
0.77
0.12
1.10
0.91
1.07
0.66
0.85
1.09
0.80
1.10
2.06
0.25
0.55
1.16
1.20
0.85
0.76
0.45
0.59
0.61
0.97
1.14
1.32
1.50
1.63
0.63
0.00
1.51
1.42
0.43
0.89
0.79
0.98
0.68
0.53
1.37
0.83
0.96
0.64
1.05
0.97
1.17
0.75
0.87
0.78
1.00
1.10
0.90
0.97
0.80
0.71
0.83
0.88
1.25
0.75
1.66
1.13
0.92
1.07
0.60
0.84
0.93
0.65
0.77
1.41
0.55
1.03
0.21
0.73
0.99
1.01
0.93
0.74
1.02
0.62
1.33
2.15 *
0.29
0.50
0.96
1.21
0.80
0.86
0.57
0.65
0.63
0.70
1.38
0.72
1.19
1.61
0.53
0.00
1.62 *
1.38
0.60
29516
267
0.90
Total
95% CI for RAMR
Cases
(0.33, 1.52)
(0.38, 3.62)
(0.01, 3.06)
(0.37, 2.23)
(0.00, 1.16)
(0.24, 1.70)
(0.36, 2.15)
(0.37, 2.20)
(0.01, 5.17)
(0.24, 1.72)
(0.61, 1.59)
(0.29, 1.13)
(0.57, 2.62)
(1.07, 3.84)
(0.00, 1.60)
(0.22, 0.99)
(0.41, 1.89)
(0.55, 2.29)
(0.49, 1.23)
(0.47, 1.44)
(0.27, 1.05)
(0.29, 1.23)
(0.13, 1.85)
(0.32, 1.32)
(0.73, 2.36)
(0.26, 1.56)
(0.62, 2.09)
(0.85, 2.74)
(0.01, 2.94)
(0.00, 1.83)
(0.91, 2.68)
(0.85, 2.10)
(0.16, 1.54)
1002
282
143
739
788
399
577
496
149
507
1657
1206
692
495
362
1376
628
673
2029
1714
2110
1358
457
821
1095
340
714
720
154
285
900
1362
866
* Risk-adjusted mortality rate significantly higher than statewide rate based on 95 percent confidence interval.
8
27096
RAMR
0.42
0.87
0.00
0.56
0.00
0.61
0.40
1.07
0.00
0.83
0.62
0.37
0.38
1.46 *
0.00
0.25
0.38
1.12
0.55
0.68
0.32
0.24
0.35
0.34
0.50
0.00
0.91
1.11
0.00
0.00
0.98
0.42
0.36
0.51
Table 2 Hospital Observed and Risk-Adjusted Mortality Rates (RAMR) for PCI in New York State, 1995 - 1997 Discharges
All Cases
Hospital
Cases
OMR
Albany Medical Center
Arnot-Ogden
Bellevue
Beth Israel
Buffalo General
Columbia Presbyterian-NYP
Crouse Hospital
Ellis Hospital
Erie County
LIJ Medical Center
Lenox Hill
Maimonides
Millard Fillmore
Montefiore - Einstein
Montefiore - Moses
2534
858
467
1835
2016
1348
1703
1402
431
1497
4792
3258
2176
1488
1084
0.83
1.75
0.64
0.76
0.15
1.11
0.88
0.86
0.46
1.14
1.29
0.77
1.19
1.75
0.46
Mount Sinai
NYU Hospitals Center
New York Hospital - Queens
North Shore
Rochester General
St. Francis
St. Josephs
St. Lukes-Roosevelt
St. Peters
St. Vincents
Strong Memorial
United Health Services
Univ. Hosp. - Stony Brook
Univ. Hosp. - Upstate
Univ. Hosp. of Brooklyn
Weill Cornell-NYP
Westchester Medical Center
Winthrop Univ. Hosp.
3630
1826
1023
5749
5004
6518
3946
1400
2483
2916
1295
2098
2032
380
829
2375
3597
2887
0.83
1.26
1.37
0.78
0.82
0.48
0.71
0.79
0.68
1.13
1.93
1.10
1.28
1.05
0.84
1.39
1.11
0.62
76877
0.92
Statewide Totals
Non-Emergency Cases
RAMR
Cases
OMR
0.99
1.84 *
0.58
0.99
0.30 **
0.85
1.19
1.06
0.52
1.13
1.11
0.63 **
1.20
1.80 *
0.45
2383
763
390
1726
1977
1197
1516
1274
424
1305
4551
3114
2066
1370
980
0.50
0.92
0.26
0.58
0.05
0.42
0.26
0.55
0.00
0.92
0.75
0.51
0.48
0.95
0.00
0.69
0.94
1.15
0.84
0.93
0.51 **
0.74
0.82
0.61
1.60 *
1.29
0.83
1.43 *
0.95
1.32
1.19
0.96
0.77
3424
1626
920
5050
4691
6198
3484
1324
2214
2802
993
1810
1846
357
799
2158
3278
2654
0.41
0.43
0.98
0.51
0.47
0.29
0.26
0.53
0.23
0.57
0.20
0.61
0.81
0.00
0.50
0.97
0.52
0.38
70664
0.49
RAMR
Emergency Cases
Cases
OMR
RAMR
0.53
1.29 *
0.28
0.49
0.07 **
0.55
0.40
0.70
0.00
0.78
0.63
0.32
0.64
1.05 *
0.00 **
151
95
77
109
39
151
187
128
7
192
241
144
110
118
104
5.96
8.42
2.60
3.67
5.13
6.62
5.88
3.91
28.57
2.60
11.62
6.25
14.55
11.02
4.81
5.81
11.84
3.63
6.90
5.06
4.48
8.64
5.13
5.58
3.99
6.29
5.02
8.53
8.22
4.66
0.31
0.38
0.72
0.50
0.52
0.28 **
0.29
0.48
0.31
0.58
0.29
0.63
0.99 *
0.00
0.57
0.92 *
0.51
0.43
206
200
103
699
313
320
462
76
269
114
302
288
186
23
30
217
319
233
7.77
8.00
4.85
2.72
6.07
4.06
4.11
5.26
4.46
14.91
7.62
4.17
5.91
17.39
10.00
5.53
7.21
3.43
4.96
7.60
5.64
4.11
5.92
3.37 **
5.82
5.50
4.29
18.05 *
9.03
4.18
6.85
11.48
13.95
4.52
6.13
4.26
6213
5.87
*
Risk adjusted mortality rate significantly higher than statewide rate based on 95 percent confidence interval.
**
Risk adjusted mortality rate significantly lower than statewide rate based on 95 percent confidence interval.
9
1995-1997 HOSPITAL AND CARDIOLOGIST DATA FOR PCI
Table 3 provides the number of PCIs, number of PCI patients who died in the hospital, observed mortality
rate, expected mortality rate, risk-adjusted mortality rate, and the 95% confidence interval for the riskadjusted mortality rate for 1995-97 for cardiologists in each of the 33 hospitals performing PCI during the
time period, and for each of the hospitals. Table 3 also contains the volume and risk-adjusted mortality rate
for cardiologists and hospitals for non-emergency cases.
This information is presented for each cardiologist (1) who performed 200 or more PCIs in that hospital
during 1995-1997, and/or (2) who performed at least one PCI in each of the years 1995-1997. The results
for cardiologists not meeting the above criteria are grouped together and reported as “All Others” in the
hospital in which the procedures were performed. Cardiologists who performed procedures in more than
one hospital are noted in the table and are listed in all hospitals in which they performed 200 or more
procedures and/or performed procedures in each of the years 1995-1997.
Also, cardiologists who met criterion (1) and/or criterion (2) above and have performed PCI in two or more
New York State hospitals are listed separately in Table 4. For these cardiologists, the table presents the
number of PCIs, the number of deaths, observed mortality rate, expected mortality rate and risk-adjusted
mortality rate with its 95 percent confidence interval for each hospital in which the cardiologist performed
PCI, as well as the aggregate numbers (across all hospitals in which the cardiologist performed procedures).
In addition, cardiologists and hospitals with risk-adjusted mortality rates that are significantly lower or higher
than the statewide mortality rate (as judged by a 95% confidence interval) are noted in Tables 3 and 4.
It should be noted that shock and hemodynamic instability are significant risk factors in the All Cases model.
However, patients with these conditions are excluded from the non-emergency analysis. The outcomes
models for the two groups can, therefore, yield substantially different risk-adjusted mortality rates. It is
important to compare provider's RAMR to the statewide average mortality rate for the specific group of
patients analyzed.
Table 3 Cardiologist Observed, Expected, and Risk-Adjusted Mortality Rates (RAMR) for PCI in New York State,
1995 - 1997 Discharges
All Cases
Cases
Albany Medical Center Hospital
Breisblatt W
#Delago A
#Desantis J
#Esper D
Houghton J
Macina A
#Marmulstein M
#Martinelli M
#Papandrea L
#Roccario E
All Others
TOTAL
Arnot-Ogden Memorial Hospital
Laifer L
Salimi A
TOTAL
10
Non-Emergency
Deaths
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
441
980
2
175
459
179
32
53
31
30
152
4
6
0
3
4
1
0
1
0
1
1
0.91
0.61
0.00
1.71
0.87
0.56
0.00
1.89
0.00
3.33
0.66
0.60
0.92
3.27
0.77
0.65
0.74
0.73
1.07
0.82
1.99
0.39
1.39
0.61
0.00
2.04
1.24
0.69
0.00
1.62
0.00
1.55
1.54
(0.38, 3.57)
(0.22, 1.33)
(0.00,51.80)
(0.41, 5.97)
(0.33, 3.17)
(0.01, 3.86)
(0.00,14.45)
(0.02, 9.02)
(0.00,13.39)
(0.02, 8.61)
(0.02, 8.57)
425
931
0
164
428
159
25
50
27
26
148
0.77
0.33
–
1.34
0.57
0.00
0.00
2.83
0.00
0.00
1.08
2534
21
0.83
0.78
0.99
(0.61, 1.51)
2383
0.53
291
567
6
9
2.06
1.59
1.00
0.81
1.91
1.80
(0.70, 4.16)
(0.82, 3.42)
254
509
1.04
1.44
858
15
1.75
0.88
1.84 *
(1.03, 3.04)
763
1.29 *
Table 3 continued
All Cases
Cases
Bellevue Hospital Center
#Attubato M
#Chinitz L
#Feit F
#Levite H
#Winer H
All Others
TOTAL
Beth Israel Medical Center
##Friedman M
#Hanley G
Reimers C
Sherman W
Wilentz J
All Others
TOTAL
Buffalo General Hospital
Arani D
Conley J
#Morris W
Paris J
Sullivan P
Visco J
TOTAL
Non-Emergency
Deaths
OMR
EMR
RAMR
95% CI for RAMR
107
25
135
108
74
18
2
0
0
1
0
0
1.87
0.00
0.00
0.93
0.00
0.00
1.68
1.29
1.06
0.65
0.65
0.35
1.03
0.00
0.00
1.32
0.00
0.00
(0.12, 3.70)
(0.00,10.54)
(0.00, 2.37)
(0.02, 7.33)
(0.00, 7.09)
(0.00,53.79)
92
17
109
94
61
17
1.17
0.00
0.00
0.00
0.00
0.00
467
3
0.64
1.03
0.58
(0.12, 1.69)
390
0.28
98
62
455
530
670
20
1
0
3
4
6
0
1.02
0.00
0.66
0.75
0.90
0.00
0.32
0.49
0.78
0.60
0.84
0.40
2.96
0.00
0.78
1.17
0.98
0.00
(0.04,16.48)
(0.00,11.05)
(0.16, 2.27)
(0.31, 3.00)
(0.36, 2.14)
(0.00,42.11)
95
61
430
488
632
20
1.82
0.00
0.38
0.40
0.58
0.00
1835
14
0.76
0.71
0.99
(0.54, 1.66)
1726
0.49
229
981
118
167
94
427
0
2
0
1
0
0
0.00
0.20
0.00
0.60
0.00
0.00
0.39
0.48
0.36
0.58
0.59
0.43
0.00
0.40
0.00
0.96
0.00
0.00
(0.00, 3.79)
(0.04, 1.43)
(0.00, 8.00)
(0.01, 5.33)
(0.00, 6.14)
(0.00, 1.83)
226
964
117
160
89
421
0.00
0.15
0.00
0.00
0.00
0.00
2016
3
0.15
0.46
0.30 **
(0.06, 0.87)
1977
0.00
2.00
0.00
1.16
0.00
0.88
0.00
3.57
0.91
0.00
1.25
25.00
1.69
0.00
0.10
1.11
0.87
1.56
0.86
1.42
0.20
0.71
3.10
0.25
0.24
0.48
0.76
1.86
(0.00,100.0)
(0.33, 4.85)
(0.00, 1.85)
(0.14, 2.00)
(0.00,100.0)
(0.01, 3.20)
(0.00,100.0)
(0.06,25.85)
(0.00, 1.51)
(0.00,15.31)
(0.06,26.73)
(0.63,100.0)
(0.41, 5.99)
(0.00, 2.20)
1
128
188
242
1
104
14
28
84
88
75
4
151
64
Columbia Presbyterian - NY Presbyterian Hospital
#Abittan M
1
0
Apfelbaum M
150
3
Arora R
210
0
Brogno D
259
3
#Ezratty A
3
0
#Grose R
113
1
#Johnson M
14
0
Lotvin A
28
1
Rabbani L
110
1
#Reison D
89
0
Schwartz A
80
1
#Shani J
4
1
Wasserman H
178
3
Weinberger J
83
0
0.00
1.66
0.00
0.68
0.00
0.57
0.00
4.65
0.27
0.00
4.80
48.27
2.05
0.00
Cases
RAMR
0.07 **
0.00
1.16
0.00
0.00
0.00
0.00
0.00
2.74
0.00
0.00
0.00
26.25
1.02
0.00
11
Table 3 continued
All Cases
Cases
Deaths
OMR
Columbia Presbyterian - NY Presbyterian Hospital (continued)
Wiedermann J
12
0
0.00
All Others
14
1
7.14
TOTAL
Crouse Hospital
#Amin N
#Battaglia J
#Berkery W
#Bowser M
#Caputo R
#Esente P
#Giambartolomei A
#Lozner E
#Picone M
#Reger M
#Simons A
#Walford G
All Others
TOTAL
Ellis Hospital
#Card H
Cospito P
Jordan M
Parkes R
Wright E
All Others
TOTAL
Erie County Medical Center
#Dashkoff N
Farhi E
#Masud Z
TOTAL
Lenox Hill Hospital
Collins M
Columbo A
##Friedman M
Kreps E
Moses J
#Shaknovich A
12
Non-Emergency
EMR
RAMR
95% CI for RAMR
Cases
RAMR
0.36
0.39
0.00
17.12
(0.00,79.34)
(0.22,95.26)
11
14
0.00
6.87
1348
15
1.11
1.20
0.85
(0.48, 1.41)
1197
0.55
148
628
152
386
17
19
25
121
82
8
86
11
20
0
7
2
3
0
0
0
2
0
0
1
0
0
0.00
1.11
1.32
0.78
0.00
0.00
0.00
1.65
0.00
0.00
1.16
0.00
0.00
0.62
0.73
1.43
0.45
0.41
0.59
0.63
0.46
0.84
0.31
0.49
0.23
0.59
0.00
1.40
0.85
1.60
0.00
0.00
0.00
3.34
0.00
0.00
2.18
0.00
0.00
(0.00, 3.72)
(0.56, 2.89)
(0.10, 3.06)
(0.32, 4.68)
(0.00,48.83)
(0.00,30.28)
(0.00,21.67)
(0.37,12.04)
(0.00, 4.91)
(0.00,100.0)
(0.03,12.12)
(0.00,100.0)
(0.00,28.81)
130
550
107
375
16
18
24
110
72
8
79
11
16
0.00
0.58
0.00
0.80
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1703
15
0.88
0.68
1.19
(0.67, 1.97)
1516
0.40
7
290
385
234
353
133
0
3
2
4
2
1
0.00
1.03
0.52
1.71
0.57
0.75
0.37
0.68
0.82
0.99
0.54
0.75
0.00
1.40
0.58
1.60
0.96
0.92
(0.00,100.0)
(0.28, 4.08)
(0.07, 2.11)
(0.43, 4.10)
(0.11, 3.47)
(0.01, 5.12)
7
273
336
211
323
124
0.00
1.07
0.49
0.00
0.82
0.80
1402
12
0.86
0.74
1.06
(0.55, 1.86)
1274
0.70
350
75
6
2
0
0
0.57
0.00
0.00
0.78
1.05
0.34
0.67
0.00
0.00
(0.08, 2.43)
(0.00, 4.30)
(0.00,100.0)
344
74
6
0.00
0.00
0.00
431
2
0.46
0.82
0.52
(0.06, 1.88)
424
0.00
362
319
77
653
1928
578
5
11
1
8
11
7
1.38
3.45
1.30
1.23
0.57
1.21
1.10
0.89
0.44
1.29
0.66
0.86
1.16
3.58 *
2.74
0.88
0.79
1.30
(0.37, 2.70)
(1.78, 6.40)
(0.04,15.26)
(0.38, 1.73)
(0.40, 1.42)
(0.52, 2.69)
352
306
73
584
1914
550
0.55
2.15 *
1.92
0.28
0.36
0.71
Table 3 continued
All Cases
Cases
Non-Emergency
Deaths
OMR
EMR
RAMR
95% CI for RAMR
771
104
17
2
2.20
1.92
2.12
2.00
0.96
0.89
(0.56, 1.54)
(0.10, 3.21)
677
95
0.68
0.77
4792
62
1.29
1.08
1.11
(0.85, 1.42)
4551
0.63
Long Island Jewish Medical Center
#Friedman G
514
#Grunwald A
472
Koss J
495
All Others
16
4
7
6
0
0.78
1.48
1.21
0.00
1.16
0.88
0.75
0.62
0.62
1.55
1.50
0.00
(0.17, 1.59)
(0.62, 3.19)
(0.55, 3.27)
(0.00,34.33)
441
406
444
14
0.52
0.80
1.13
0.00
1497
17
1.14
0.93
1.13
(0.66, 1.81)
1305
0.78
949
560
1749
7
4
14
0.74
0.71
0.80
1.27
0.50
1.26
0.54
1.31
0.59
(0.21, 1.10)
(0.35, 3.36)
(0.32, 0.98)
887
557
1670
0.14
0.59
0.35
3258
25
0.77
1.13
0.63 **
(0.40, 0.92)
3114
0.32
192
626
3
166
529
647
13
0
10
0
1
8
7
0
0.00
1.60
0.00
0.60
1.51
1.08
0.00
0.66
1.07
0.58
0.50
0.71
1.13
0.41
0.00
1.37
0.00
1.11
1.98
0.89
0.00
(0.00, 2.66)
(0.66, 2.53)
(0.00,100.0)
(0.01, 6.15)
(0.85, 3.90)
(0.35, 1.82)
(0.00,62.89)
188
589
3
156
508
611
11
0.00
0.79
0.00
0.74
1.13
0.22
0.00
2176
26
1.19
0.92
1.20
(0.79, 1.77)
2066
0.64
Montefiore Medical Center - Einstein Division
Jordan A
160
0
Lerrick K
297
8
Monrad E
436
10
Silverman G
293
4
Strom J
187
3
All Others
115
1
0.00
2.69
2.29
1.37
1.60
0.87
0.55
1.50
0.76
0.62
1.11
0.68
0.00
1.66
2.78 *
2.04
1.33
1.17
(0.00, 3.83)
(0.72, 3.28)
(1.33, 5.11)
(0.55, 5.23)
(0.27, 3.90)
(0.02, 6.53)
151
265
411
269
173
101
0.00
0.60
2.02 *
0.92
0.70
1.09
1.75
0.90
1.80 *
(1.18, 2.64)
1370
1.05 *
Lenox Hill Hospital (continued)
Strain J
All Others
TOTAL
TOTAL
Maimonides Medical Center
Frankel R
Sacchi T
#Shani J
TOTAL
Millard Fillmore Hospital
Calandra S
Corbelli J
#Dashkoff N
Gelormini J
#Masud Z
#Morris W
All Others
TOTAL
TOTAL
1488
26
Cases
RAMR
13
Table 3 continued
All Cases
Cases
Deaths
Montefiore Medical Center - Moses Division
Greenberg M
407
1
#Grose R
182
0
#Johnson M
131
1
Menegus M
349
2
All Others
15
1
TOTAL
Non-Emergency
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
0.25
0.00
0.76
0.57
6.67
0.74
1.58
0.60
0.97
2.05
0.31
0.00
1.18
0.55
3.00
(0.00, 1.72)
(0.00, 1.18)
(0.02, 6.59)
(0.06, 1.98)
(0.04,16.70)
373
168
126
300
13
0.00
0.00
0.00
0.00
0.00
1084
5
0.46
0.95
0.45
(0.14, 1.04)
980
0.00 **
391
440
655
467
1677
1
7
12
6
4
0.26
1.59
1.83
1.28
0.24
0.79
1.40
1.26
1.18
1.01
0.30
1.05
1.34
1.01
0.22 **
(0.00, 1.67)
(0.42, 2.17)
(0.69, 2.34)
(0.37, 2.20)
(0.06, 0.56)
381
406
588
441
1608
0.00
0.79
0.57
0.69
0.09 **
3630
30
0.83
1.10
0.69
(0.47, 0.99)
3424
0.31
2
13
107
9
290
425
177
0
0
2
0
4
5
3
0.00
0.00
1.87
0.00
1.38
1.18
1.69
0.57
0.47
0.51
0.78
1.33
1.11
1.14
0.00
0.00
3.39
0.00
0.96
0.98
1.37
(0.00,100.0)
(0.00,55.17)
(0.38,12.25)
(0.00,48.46)
(0.26, 2.46)
(0.32, 2.29)
(0.28, 4.01)
2
12
106
7
255
385
153
0.00
0.00
1.80
0.00
0.53
0.55
1.09
1023
14
1.37
1.10
1.15
(0.63, 1.93)
920
0.72
New York University Hospitals Center
#Attubato M
420
#Chinitz L
122
#Feit F
458
#Levite H
333
#Winer H
293
All Others
200
3
1
6
6
6
1
0.71
0.82
1.31
1.80
2.05
0.50
0.80
1.34
1.29
1.86
1.25
0.92
0.82
0.56
0.94
0.89
1.52
0.50
(0.17, 2.41)
(0.01, 3.13)
(0.34, 2.04)
(0.33, 1.94)
(0.55, 3.30)
(0.01, 2.80)
385
109
416
274
255
187
0.49
0.00
0.00
0.57
0.98
0.00
1826
23
1.26
1.24
0.94
(0.60, 1.41)
1626
0.38
North Shore University Hospital
##Feld H
3
Green S
985
##Gustafson G
112
Kaplan B
671
Katz S
1111
Ong L Y
983
Padmanabhan V
715
0
13
0
8
12
4
2
0.00
1.32
0.00
1.19
1.08
0.41
0.28
0.26
0.88
0.54
1.05
0.99
1.04
0.58
0.00
1.38
0.00
1.05
1.01
0.36
0.45
(0.00,100.0)
(0.74, 2.37)
(0.00, 5.62)
(0.45, 2.07)
(0.52, 1.77)
(0.10, 0.93)
(0.05, 1.61)
3
822
112
560
932
839
649
0.00
0.83
0.00
0.94
0.60
0.23
0.23
Mount Sinai Hospital
Ambrose J
Cocke T
Duvvuri S
Marmur J
Sharma S
TOTAL
New York Hospital - Queens
##Feld H
#Friedman G
#Geizhals M
#Grunwald A
##Gustafson G
#Wong S
All Others
TOTAL
TOTAL
14
Table 3 continued
All Cases
Cases
Deaths
OMR
EMR
RAMR
95% CI for RAMR
2
2
1
1
0
0.99
0.52
0.55
0.33
0.00
0.60
0.76
0.82
0.43
1.16
1.52
0.63
0.62
0.69
0.00
(0.17, 5.49)
(0.07, 2.27)
(0.01, 3.46)
(0.01, 3.86)
(0.00, 3.21)
200
374
179
299
81
0.73
0.21
0.32
0.42
0.00
5749
45
0.78
0.86
0.84
(0.61, 1.12)
5050
0.50
833
260
409
523
1792
120
207
254
547
59
3
5
2
3
13
1
3
6
5
0
0.36
1.92
0.49
0.57
0.73
0.83
1.45
2.36
0.91
0.00
0.72
0.70
1.25
0.48
0.58
0.55
1.16
1.65
1.25
1.23
0.46
2.53
0.36
1.10
1.16
1.39
1.15
1.32
0.67
0.00
(0.09, 1.35)
(0.82, 5.91)
(0.04, 1.30)
(0.22, 3.21)
(0.62, 1.99)
(0.02, 7.75)
(0.23, 3.36)
(0.48, 2.87)
(0.22, 1.57)
(0.00, 4.67)
803
240
347
505
1743
118
188
202
490
55
0.31
1.08
0.00
0.00
0.74
1.05
0.90
0.52
0.00
0.00
5004
41
0.82
0.81
0.93
(0.67, 1.27)
4691
0.52
737
502
503
283
300
359
235
206
243
118
627
578
136
242
954
225
270
1
6
1
1
2
2
1
0
4
0
2
5
0
2
3
0
1
0.14
1.20
0.20
0.35
0.67
0.56
0.43
0.00
1.65
0.00
0.32
0.87
0.00
0.83
0.31
0.00
0.37
0.91
1.83
0.70
1.13
0.62
0.55
0.39
0.81
1.26
1.12
0.66
0.85
0.68
0.97
0.69
0.51
1.06
0.14 **
0.60
0.26
0.29
0.99
0.93
1.00
0.00
1.21
0.00
0.44
0.94
0.00
0.79
0.42
0.00
0.32
(0.00, 0.77)
(0.22, 1.32)
(0.00, 1.45)
(0.00, 1.61)
(0.11, 3.57)
(0.10, 3.37)
(0.01, 5.55)
(0.00, 2.02)
(0.33, 3.09)
(0.00, 2.57)
(0.05, 1.60)
(0.30, 2.20)
(0.00, 3.67)
(0.09, 2.85)
(0.08, 1.22)
(0.00, 2.94)
(0.00, 1.80)
703
461
473
259
289
348
233
186
222
107
602
557
135
237
918
216
252
0.11
0.63
0.23
0.00
0.33
0.38
0.66
0.00
0.51
0.00
0.21
0.59
0.00
0.00
0.26
0.00
0.00
6518
31
0.48
0.86
0.51 **
(0.34, 0.72)
North Shore University Hospital (continued)
#Sassower M
202
#Schwartz R
387
#Wong S
182
Zisfein J
307
All Others
91
TOTAL
Rochester General Hospital
Doling M
Fitzpatrick P
Gagioch G
Mathew T
Ong L S
Resnick R
Scortichini D
Stuver T
Thompson M
All Others
TOTAL
St. Francis Hospital
#Abittan M
Berke A
#Ezratty A
Gulotta R
Gulotta S
Hamby R
Hershman R
#Lituchy A
Minadeo J
Monteleone B
Pappas T
Petrossian G
Randall A
Reduto L
Schlofmitz R
Venditto J
All Others
TOTAL
Non-Emergency
Cases
6198
RAMR
0.28 **
15
Table 3 continued
All Cases
Cases
Non-Emergency
Deaths
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
124
8
434
881
681
53
146
603
388
566
62
1
0
2
6
8
0
0
2
3
6
0
0.81
0.00
0.46
0.68
1.17
0.00
0.00
0.33
0.77
1.06
0.00
1.65
5.52
0.92
0.79
1.16
0.51
0.60
0.79
0.85
0.74
0.52
0.45
0.00
0.46
0.79
0.94
0.00
0.00
0.39
0.84
1.32
0.00
(0.01, 2.51)
(0.00, 7.67)
(0.05, 1.66)
(0.29, 1.72)
(0.40, 1.84)
(0.00,12.62)
(0.00, 3.85)
(0.04, 1.39)
(0.17, 2.47)
(0.48, 2.87)
(0.00,10.41)
85
0
382
804
609
40
117
553
337
500
57
0.00
0.00
0.00
0.14
0.77
0.00
0.00
0.27
0.33
0.26
0.00
3946
28
0.71
0.89
0.74
(0.49, 1.06)
3484
0.29
1
1
0
0
1
0
0
7
1
0.39
0.57
0.00
0.00
2.94
0.00
0.00
0.93
2.22
0.75
0.75
0.13
0.87
2.18
0.43
0.55
0.89
1.51
0.48
0.71
0.00
0.00
1.25
0.00
0.00
0.96
1.36
(0.01, 2.67)
(0.01, 3.95)
(0.00,100.0)
(0.00, 3.23)
(0.02, 6.95)
(0.00,100.0)
(0.00,100.0)
(0.39, 1.99)
(0.02, 7.59)
250
166
7
104
28
2
4
720
43
0.32
0.00
0.00
0.00
0.00
0.00
0.00
0.66
2.40
1400
11
0.79
0.89
0.82
(0.41, 1.46)
1324
0.48
136
14
387
154
203
364
435
209
466
115
0
1
3
1
2
2
1
1
6
0
0.00
7.14
0.78
0.65
0.99
0.55
0.23
0.48
1.29
0.00
0.38
9.37
0.87
1.12
0.60
1.10
1.01
1.14
1.29
0.73
0.00
0.70
0.82
0.53
1.50
0.46
0.21
0.39
0.92
0.00
(0.00, 6.60)
(0.01, 3.92)
(0.16, 2.39)
(0.01, 2.97)
(0.17, 5.43)
(0.05, 1.66)
(0.00, 1.17)
(0.01, 2.16)
(0.34, 2.00)
(0.00, 4.02)
133
11
369
128
198
317
378
191
388
101
0.00
0.00
1.25
0.00
0.63
0.40
0.00
0.00
0.00
0.00
2483
17
0.68
1.04
0.61
(0.35, 0.97)
2214
0.31
St. Josephs Hospital Health Center
#Amin N
#Bowser M
#Caputo R
#Esente P
#Giambartolomei A
#Lozner E
#Picone M
#Reger M
#Simons A
#Walford G
All Others
TOTAL
St. Lukes Roosevelt Hospital-St. Lukes Div.
#Geizhals M
258
Goldman A
174
Hirsch C
7
Leber R
121
Palazzo A
34
#Reison D
2
#Rentrop K
4
Slater J
755
All Others
45
TOTAL
St. Peters Hospital
#Card H
#Delago A
#Desantis J
#Esper D
Herman B
#Marmulstein M
#Martinelli M
#Papandrea L
#Roccario E
All Others
TOTAL
16
Table 3 continued
All Cases
Cases
St. Vincents Hospital and Medical Center
Acuna D
150
Bloomfield D
31
Braff R
116
Coppola J
354
Dominguez A
211
Elmquist T
87
##Feld H
293
##Friedman M
3
Homayuni A
324
#Kwan T
84
Malpeso J
182
#Rentrop K
573
Seldon M
202
Snyder S
135
Warchol A
72
All Others
99
TOTAL
2916
Deaths
OMR
EMR
RAMR
3
0
1
4
3
5
4
0
2
0
2
3
4
1
0
1
2.00
0.00
0.86
1.13
1.42
5.75
1.37
0.00
0.62
0.00
1.10
0.52
1.98
0.74
0.00
1.01
0.52
0.29
0.56
0.64
0.71
1.34
1.14
0.24
0.66
0.38
0.47
0.55
0.71
0.37
0.38
0.57
3.54
0.00
1.43
1.62
1.84
3.95 *
1.10
0.00
0.86
0.00
2.16
0.89
2.57
1.83
0.00
1.63
(0.71,10.33)
(0.00,37.19)
(0.02, 7.97)
(0.44, 4.15)
(0.37, 5.38)
(1.27, 9.22)
(0.30, 2.83)
(0.00,100.0)
(0.10, 3.11)
(0.00,10.54)
(0.24, 7.80)
(0.18, 2.59)
(0.69, 6.58)
(0.02,10.20)
(0.00,12.44)
(0.02, 9.05)
134
31
113
326
207
76
284
3
311
83
178
568
189
134
70
95
33
1.13
0.65
1.60 *
(1.10, 2.25)
2802
0.58
0.00
0.00
0.56
2.94
1.12
1.23
1.00
0.86
0.00
0.00
0.52
3.16
(0.00,75.70)
(0.00, 2.87)
(0.01, 2.88)
(0.64, 9.24)
4
88
172
93
0.00
0.00
0.00
0.00
State University Hospital Upstate Medical Center
#Battaglia J
4
0
#Berkery W
96
0
Patrone V
178
1
Phadke K
102
3
TOTAL
Strong Memorial Hospital
Cunningham M
Ling F
Pomerantz R
TOTAL
95% CI for RAMR
Cases
RAMR
3.19 *
0.00
0.93
0.00
0.33
1.14
0.39
0.00
0.00
0.00
1.65
0.58
0.58
1.01
0.00
0.86
380
4
1.05
1.02
0.95
(0.26, 2.43)
357
0.00
436
590
269
5
11
9
1.15
1.86
3.35
1.64
1.14
1.50
0.65
1.51
2.06 *
(0.21, 1.51)
(0.75, 2.70)
(0.94, 3.92)
336
469
188
0.41
0.28
0.00
1295
25
1.93
1.38
1.29
(0.83, 1.90)
993
0.29
5
8
3
0
6
1
0.79
2.31
0.68
0.00
1.22
3.70
1.42
1.60
0.78
1.38
1.01
1.79
0.52
1.33
0.80
0.00
1.12
1.91
(0.17, 1.20)
(0.57, 2.62)
(0.16, 2.34)
(0.00, 1.56)
(0.41, 2.43)
(0.02,10.61)
520
291
404
120
451
24
0.36
0.97
0.67
0.00
0.85
1.36
23
1.10
1.22
0.83
(0.53, 1.24)
1810
0.63
United Health Services - Wilson Division
Jamal N
632
Kashou J
347
Phillips W
444
Stamato N
157
Traverse P
491
All Others
27
TOTAL
Non-Emergency
2098
17
Table 3 continued
All Cases
Cases
Deaths
OMR
EMR
RAMR
3
9
2
7
4
1
1.40
2.51
0.38
1.94
1.18
0.44
1.39
0.83
0.40
1.41
0.63
0.68
0.93
2.79 *
0.87
1.27
1.74
0.60
(0.19, 2.73)
(1.27, 5.29)
(0.10, 3.16)
(0.51, 2.62)
(0.47, 4.46)
(0.01, 3.33)
180
325
517
307
308
209
0.76
1.66 *
0.32
0.94
1.57
0.00
2032
26
1.28
0.83
1.43 *
(0.93, 2.09)
1846
0.99 *
272
168
26
160
73
130
5
0
0
2
0
0
1.84
0.00
0.00
1.25
0.00
0.00
0.55
0.52
1.70
0.67
0.35
0.58
3.11 *
0.00
0.00
1.72
0.00
0.00
(1.00, 7.27)
(0.00, 3.88)
(0.00, 7.65)
(0.19, 6.20)
(0.00,13.44)
(0.00, 4.46)
261
162
25
150
73
128
1.40
0.00
0.00
0.70
0.00
0.00
829
7
0.84
0.59
1.32
(0.53, 2.73)
799
0.57
6
8
2
0
0
9
5
3
1.54
1.58
1.89
0.00
0.00
1.43
1.36
1.09
1.57
1.31
0.53
0.54
0.48
0.79
0.96
1.22
0.91
1.12
3.31
0.00
0.00
1.68
1.31
0.82
(0.33, 1.97)
(0.48, 2.20)
(0.37,11.94)
(0.00,19.58)
(0.00,10.12)
(0.77, 3.19)
(0.42, 3.06)
(0.17, 2.41)
341
456
103
30
69
574
348
237
0.52
0.83
1.82
0.00
0.00
1.03
1.21
0.82
2375
33
1.39
1.08
1.19
(0.82, 1.67)
2158
303
570
947
916
732
129
0
8
13
8
10
1
0.00
1.40
1.37
0.87
1.37
0.78
0.56
1.32
1.30
1.12
0.81
0.56
0.00
0.98
0.98
0.72
1.55
1.28
(0.00, 1.98)
(0.42, 1.94)
(0.52, 1.67)
(0.31, 1.42)
(0.74, 2.85)
(0.02, 7.10)
290
509
851
831
673
124
0.00
0.47
0.63
0.34
0.97
0.00
3597
40
1.11
1.07
0.96
(0.69, 1.31)
3278
0.51
University Hospital at Stony Brook
Chernilas J
214
Dervan J
359
Grella R
532
Lawson W
361
Novotny H
339
All Others
227
TOTAL
University Hospital of Brooklyn
Chadow H
Feit A
#Hanley G
#Kwan T
#Reddy C
All Others
TOTAL
Weill Cornell - NY Presbyterian Hospital
Altmann D
390
Bergman G
505
##Gustafson G
106
#Lituchy A
32
#Reddy C
70
Sanborn T
628
#Shaknovich A
368
All Others
276
TOTAL
Westchester Medical Center
Charney R
Cohen M
Monsen C
Pucillo A
Weiss M
All Others
TOTAL
18
Non-Emergency
95% CI for RAMR
Cases
RAMR
0.92 *
Table 3 continued
All Cases
Winthrop - University Hospital
Gambino A
Heller L
Marzo K
#Sassower M
#Schwartz R
All Others
TOTAL
STATEWIDE TOTAL
*
**
#
##
Non-Emergency
Cases
Deaths
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
1854
258
751
8
12
4
11
4
3
0
0
0
0.59
1.55
0.40
0.00
0.00
0.00
0.66
1.41
0.73
1.73
0.68
0.28
0.83
1.02
0.51
0.00
0.00
0.00
(0.41, 1.49)
(0.27, 2.61)
(0.10, 1.48)
(0.00,24.44)
(0.00,41.36)
(0.00,100.0)
1750
207
673
8
12
4
0.47
1.15
0.17
0.00
0.00
0.00
2887
18
0.62
0.75
0.77
(0.46, 1.22)
2654
0.43
76877
710
0.92
70664
0.49
Risk-adjusted mortality rate significantly higher than statewide rate based on 95 percent confidence interval.
Risk-adjusted mortality rate significantly lower than statewide rate based on 95 percent confidence interval.
Performed procedures in another New York State hospital.
Performed procedures in two or more other New York State hospitals.
19
Table 4 Summary Information for Cardiologists Practicing at More than One Hospital, 1995 - 1997
All Cases
Non-Emergency
Cases
Deaths
OMR
EMR
RAMR
Abittan M
Columbia Presbyterian
St. Francis
738
1
737
1
0
1
0.14
0.00
0.14
0.91
0.10
0.91
0.14 **
0.00
0.14 **
Amin N
Crouse
St. Josephs
272
148
124
1
0
1
0.37
0.00
0.81
1.09
0.62
1.65
Attubato M
Bellevue
NYU Hospitals Center
527
107
420
5
2
3
0.95
1.87
0.71
Battaglia J
Crouse
Upstate Med Ctr
632
628
4
7
7
0
Berkery W
Crouse
Upstate Med Ctr
248
152
96
Bowser M
Crouse
Cases
RAMR
(0.00, 0.77)
(0.00,100.0)
(0.00, 0.77)
704
1
703
0.11
0.00
0.11
0.31
0.00
0.45
(0.00, 1.74)
(0.00, 3.72)
(0.01, 2.51)
215
130
85
0.00
0.00
0.00
0.98
1.68
0.80
0.89
1.03
0.82
(0.29, 2.09)
(0.12, 3.70)
(0.17, 2.41)
477
92
385
0.60
1.17
0.49
1.11
1.11
0.00
0.74
0.73
1.12
1.39
1.40
0.00
(0.56, 2.86)
(0.56, 2.89)
(0.00,75.70)
554
550
4
0.57
0.58
0.00
2
2
0
0.81
1.32
0.00
1.36
1.43
1.23
0.55
0.85
0.00
(0.06, 1.98)
(0.10, 3.06)
(0.00, 2.87)
195
107
88
0.00
0.00
0.00
394
386
3
3
0.76
0.78
0.55
0.45
1.28
1.60
(0.26, 3.73)
(0.32, 4.68)
375
375
0.80
0.80
St. Josephs
8
0
0.00
5.52
0.00
(0.00, 7.67)
0
0.00
Caputo R
Crouse
St. Josephs
451
17
434
2
0
2
0.44
0.00
0.46
0.90
0.41
0.92
0.45
0.00
0.46
(0.05, 1.64)
(0.00,48.83)
(0.05, 1.66)
398
16
382
0.00
0.00
0.00
Card H
Ellis Hospital
St. Peters
143
7
136
0
0
0
0.00
0.00
0.00
0.38
0.37
0.38
0.00
0.00
0.00
(0.00, 6.29)
(0.00,100.0)
(0.00, 6.60)
140
7
133
0.00
0.00
0.00
Chinitz L
Bellevue
NYU Hospitals Center
147
25
122
1
0
1
0.68
0.00
0.82
1.33
1.29
1.34
0.47
0.00
0.56
(0.01, 2.62)
(0.00,10.54)
(0.01, 3.13)
126
17
109
0.00
0.00
0.00
Dashkoff N
Erie County
Millard Fillmore
353
350
3
2
2
0
0.57
0.57
0.00
0.78
0.78
0.58
0.67
0.67
0.00
(0.08, 2.42)
(0.08, 2.43)
(0.00,100.0)
347
344
3
0.00
0.00
0.00
Delago A
Albany Med Ctr
St. Peters
994
980
14
7
6
1
0.70
0.61
7.14
1.04
0.92
9.37
0.62
0.61
0.70
(0.25, 1.29)
(0.22, 1.33)
(0.01, 3.92)
942
931
11
0.33
0.33
0.00
Desantis J
Albany Med Ctr
St. Peters
389
2
387
3
0
3
0.77
0.00
0.78
0.89
3.27
0.87
0.80
0.00
0.82
(0.16, 2.35)
(0.00,51.80)
(0.16, 2.39)
369
0
369
1.25
0.00
1.25
Esente P
Crouse
St. Josephs
900
19
881
6
0
6
0.67
0.00
0.68
0.79
0.59
0.79
0.78
0.00
0.79
(0.28, 1.70)
(0.00,30.28)
(0.29, 1.72)
822
18
804
0.14
0.00
0.14
20
95% CI for RAMR
Table 4 continued
All Cases
Non-Emergency
Cases
Deaths
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
Esper D
Albany Med Ctr
St. Peters
329
175
154
4
3
1
1.22
1.71
0.65
0.94
0.77
1.12
1.20
2.04
0.53
(0.32, 3.07)
(0.41, 5.97)
(0.01, 2.97)
292
164
128
0.79
1.34
0.00
Ezratty A
Columbia Presbyterian
St. Francis
506
3
503
1
0
1
0.20
0.00
0.20
0.70
0.86
0.70
0.26
0.00
0.26
(0.00, 1.44)
(0.00,100.0)
(0.00, 1.45)
474
1
473
0.23
0.00
0.23
Feit F
Bellevue
NYU Hospitals Center
593
135
458
6
0
6
1.01
0.00
1.31
1.24
1.06
1.29
0.76
0.00
0.94
(0.28, 1.64)
(0.00, 2.37)
(0.34, 2.04)
525
109
416
0.00
0.00
0.00
Feld H
New York Hosp-Queens
North Shore
St. Vincents
298
2
3
293
4
0
0
4
1.34
0.00
0.00
1.37
1.13
0.57
0.26
1.14
1.10
0.00
0.00
1.10
(0.30, 2.81)
(0.00,100.0)
(0.00,100.0)
(0.30, 2.83)
289
2
3
284
0.39
0.00
0.00
0.39
Friedman G
Long Island Jewish
New York Hosp-Queens
527
514
13
4
4
0
0.76
0.78
0.00
1.14
1.16
0.47
0.62
0.62
0.00
(0.17, 1.58)
(0.17, 1.59)
(0.00,55.17)
453
441
12
0.51
0.52
0.00
Friedman M
Beth Israel
Lenox Hill
St. Vincents
178
98
77
3
2
1
1
0
1.12
1.02
1.30
0.00
0.37
0.32
0.44
0.24
2.82
2.96
2.74
0.00
(0.32,10.17)
(0.04,16.48)
(0.04,15.26)
(0.00,100.0)
171
95
73
3
1.85
1.82
1.92
0.00
Geizhals M
New York Hosp-Queens
St. Lukes
365
107
258
3
2
1
0.82
1.87
0.39
0.68
0.51
0.75
1.12
3.39
0.48
(0.23, 3.28)
(0.38,12.25)
(0.01, 2.67)
356
106
250
0.71
1.80
0.32
Giambartolomei A
Crouse
St. Josephs
706
25
681
8
0
8
1.13
0.00
1.17
1.14
0.63
1.16
0.92
0.00
0.94
(0.40, 1.81)
(0.00,21.67)
(0.40, 1.84)
633
24
609
0.74
0.00
0.77
Grose R
Columbia Presbyterian
Montefiore-Moses Div
295
113
182
1
1
0
0.34
0.88
0.00
1.52
1.42
1.58
0.21
0.57
0.00
(0.00, 1.15)
(0.01, 3.20)
(0.00, 1.18)
272
104
168
0.00
0.00
0.00
Grunwald A
Long Island Jewish
New York Hosp-Queens
481
472
9
7
7
0
1.46
1.48
0.00
0.88
0.88
0.78
1.52
1.55
0.00
(0.61, 3.14)
(0.62, 3.19)
(0.00,48.46)
413
406
7
0.79
0.80
0.00
Gustafson G
New York Hosp-Queens
North Shore
Weill Cornell
508
290
112
106
6
4
0
2
1.18
1.38
0.00
1.89
0.99
1.33
0.54
0.53
1.11
0.96
0.00
3.31
(0.40, 2.41)
(0.26, 2.46)
(0.00, 5.62)
(0.37,11.94)
470
255
112
103
0.66
0.53
0.00
1.82
88
62
26
0
0
0
0.00
0.00
0.00
0.85
0.49
1.70
0.00
0.00
0.00
(0.00, 4.52)
(0.00,11.05)
(0.00, 7.65)
86
61
25
0.00
0.00
0.00
Hanley G
Beth Israel
Univ Hosp Brooklyn
21
Table 4 continued
All Cases
Non-Emergency
Cases
Deaths
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
Johnson M
Columbia Presbyterian
Montefiore-Moses Div
145
14
131
1
0
1
0.69
0.00
0.76
0.56
0.20
0.60
1.14
0.00
1.18
(0.01, 6.36)
(0.00,100.0)
(0.02, 6.59)
140
14
126
0.00
0.00
0.00
Kwan T
St. Vincents
Univ Hosp Brooklyn
244
84
160
2
0
2
0.82
0.00
1.25
0.57
0.38
0.67
1.32
0.00
1.72
(0.15, 4.77)
(0.00,10.54)
(0.19, 6.20)
233
83
150
0.44
0.00
0.70
Levite H
Bellevue
NYU Hospitals Center
441
108
333
7
1
6
1.59
0.93
1.80
1.57
0.65
1.86
0.94
1.32
0.89
(0.37, 1.93)
(0.02, 7.33)
(0.33, 1.94)
368
94
274
0.47
0.00
0.57
Lituchy A
St. Francis
Weill Cornell
238
206
32
0
0
0
0.00
0.00
0.00
0.78
0.81
0.54
0.00
0.00
0.00
(0.00, 1.83)
(0.00, 2.02)
(0.00,19.58)
216
186
30
0.00
0.00
0.00
Lozner E
Crouse
St. Josephs
174
121
53
2
2
0
1.15
1.65
0.00
0.47
0.46
0.51
2.25
3.34
0.00
(0.25, 8.11)
(0.37,12.04)
(0.00,12.62)
150
110
40
0.00
0.00
0.00
Marmulstein M
Albany Med Ctr
St. Peters
396
32
364
2
0
2
0.51
0.00
0.55
1.07
0.73
1.10
0.43
0.00
0.46
(0.05, 1.57)
(0.00,14.45)
(0.05, 1.66)
342
25
317
0.38
0.00
0.40
Martinelli M
Albany Med Ctr
St. Peters
488
53
435
2
1
1
0.41
1.89
0.23
1.01
1.07
1.01
0.37
1.62
0.21
(0.04, 1.35)
(0.02, 9.02)
(0.00, 1.17)
428
50
378
0.33
2.83
0.00
Masud Z
Erie County
Millard Fillmore
535
6
529
8
0
8
1.50
0.00
1.51
0.70
0.34
0.71
1.97
0.00
1.98
(0.85, 3.88)
(0.00,100.0)
(0.85, 3.90)
514
6
508
1.11
0.00
1.13
Morris W
Buffalo General
Millard Fillmore
765
118
647
7
0
7
0.92
0.00
1.08
1.01
0.36
1.13
0.84
0.00
0.89
(0.34, 1.72)
(0.00, 8.00)
(0.35, 1.82)
728
117
611
0.19
0.00
0.22
Papandrea L
Albany Med Ctr
St. Peters
240
31
209
1
0
1
0.42
0.00
0.48
1.10
0.82
1.14
0.35
0.00
0.39
(0.00, 1.95)
(0.00,13.39)
(0.01, 2.16)
218
27
191
0.00
0.00
0.00
Picone M
Crouse
St. Josephs
228
82
146
0
0
0
0.00
0.00
0.00
0.69
0.84
0.60
0.00
0.00
0.00
(0.00, 2.16)
(0.00, 4.91)
(0.00, 3.85)
189
72
117
0.00
0.00
0.00
Reddy C
Univ Hosp Brooklyn
Weill Cornell
143
73
70
0
0
0
0.00
0.00
0.00
0.41
0.35
0.48
0.00
0.00
0.00
(0.00, 5.77)
(0.00,13.44)
(0.00,10.12)
142
73
69
0.00
0.00
0.00
Reger M
Crouse
St. Josephs
611
8
603
2
0
2
0.33
0.00
0.33
0.79
0.31
0.79
0.38
0.00
0.39
(0.04, 1.39)
(0.00,100.0)
(0.04, 1.39)
561
8
553
0.27
0.00
0.27
22
Table 4 continued
All Cases
Cases
Non-Emergency
Deaths
OMR
EMR
RAMR
95% CI for RAMR
Cases
RAMR
91
89
2
0
0
0
0.00
0.00
0.00
0.25
0.25
0.43
0.00
0.00
0.00
(0.00,14.73)
(0.00,15.31)
(0.00,100.0)
90
88
2
0.00
0.00
0.00
Rentrop K
St. Lukes
St. Vincents
577
4
573
3
0
3
0.52
0.00
0.52
0.55
0.55
0.55
0.88
0.00
0.89
(0.18, 2.57)
(0.00,100.0)
(0.18, 2.59)
572
4
568
0.57
0.00
0.58
Roccario E
Albany Med Ctr
St. Peters
496
30
466
7
1
6
1.41
3.33
1.29
1.33
1.99
1.29
0.98
1.55
0.92
(0.39, 2.01)
(0.02, 8.61)
(0.34, 2.00)
414
26
388
0.00
0.00
0.00
Sassower M
North Shore
Winthrop Univ Hosp
210
202
8
2
2
0
0.95
0.99
0.00
0.64
0.60
1.73
1.36
1.52
0.00
(0.15, 4.93)
(0.17, 5.49)
(0.00,24.44)
208
200
8
0.65
0.73
0.00
Schwartz R
North Shore
Winthrop Univ Hosp
399
387
12
2
2
0
0.50
0.52
0.00
0.76
0.76
0.68
0.61
0.63
0.00
(0.07, 2.21)
(0.07, 2.27)
(0.00,41.36)
386
374
12
0.20
0.21
0.00
Shaknovich A
Lenox Hill
Weill Cornell
946
578
368
12
7
5
1.27
1.21
1.36
0.90
0.86
0.96
1.31
1.30
1.31
(0.67, 2.28)
(0.52, 2.69)
(0.42, 3.06)
898
550
348
0.92
0.71
1.21
1753
4
1749
15
1
14
0.86
25.00
0.80
1.26
0.48
1.26
0.63
48.27
0.59
(0.35, 1.04)
(0.63,100.0)
(0.32, 0.98)
1674
4
1670
0.39
26.25
0.35
Simons A
Crouse
St. Josephs
474
86
388
4
1
3
0.84
1.16
0.77
0.78
0.49
0.85
1.00
2.18
0.84
(0.27, 2.55)
(0.03,12.12)
(0.17, 2.47)
416
79
337
0.27
0.00
0.33
Walford G
Crouse
St. Josephs
577
11
566
6
0
6
1.04
0.00
1.06
0.73
0.23
0.74
1.31
0.00
1.32
(0.48, 2.86)
(0.00,100.0)
(0.48, 2.87)
511
11
500
0.26
0.00
0.26
Winer H
Bellevue
NYU Hospitals Center
367
74
293
6
0
6
1.63
0.00
2.05
1.12
0.65
1.25
1.34
0.00
1.52
(0.49, 2.92)
(0.00, 7.09)
(0.55, 3.30)
316
61
255
0.85
0.00
0.98
Wong S
New York Hosp-Queens
North Shore
607
425
182
6
5
1
0.99
1.18
0.55
1.02
1.11
0.82
0.89
0.98
0.62
(0.33, 1.94)
(0.32, 2.29)
(0.01, 3.46)
564
385
179
0.47
0.55
0.32
Reison D
Columbia Presbyterian
St. Lukes
Shani J
Columbia Presbyterian
Maimonides
*
Risk-adjusted mortality rate is significantly higher than statewide rate.
** Risk-adjusted mortality rate is significantly lower than statewide rate.
23
Criteria Used in Reporting Significant Risk Factors (1997)
Based on Documentation in Medical Record
Patient Risk Factor
Definitions
Hemodynamic State
• Unstable
Determined just prior to surgery
Patient requires pharmacologic or mechanical support to
maintain blood pressure or cardiac output
Acute hypotension (systolic blood pressure <80 mmHg)
or low cardiac index (<2.0 liters/min/m2), despite
pharmacologic or mechanical support
Patient requires cardiopulmonary resuscitation immediately
prior to the procedure
• Shock
• Cardiopulmonary Resuscitation
Comorbidities
• Chronic Obstructive
Pulmonary Disease
• Diabetes Requiring Medication
• Renal Failure, Dialysis
• Renal Failure, Creatinine >2.5
Patient requires chronic (longer than three months),
bronchodilator therapy to avoid disability from obstructive
airway disease; or has a forced expiratory volume in one
second of less than 75% of the predicted value or less than
1.25 liters; or has a room air pO2 <60 or a pCO2 >50
The patient is receiving either oral hypoglycemics or insulin
The patient is on chronic peritoneal or hemodialysis
Pre-angioplasty creatinine greater than 2.5 mg/dl
Severity of Atherosclerotic Process
• Aortoiliac Disease
• Femoral/Popliteal Disease
• Carotid/Cerebrovascular Disease
Angiographic demonstration of at least 50% narrowing in a
major aortoiliac vessel, previous surgery for such disease,
absent femoral pulses, or inability to insert a catheter or
intra-aortic balloon due to iliac aneurysm or obstruction of
the aortoiliac arteries
Angiographic demonstration of at least 50% narrowing in
a major femoral/popliteal vessel, previous surgery for such
disease, absent pedal pulses, or inability to insert a catheter
or intra-aortic balloon due to obstruction in the femoral
arteries
Angiographic or ultrasound demonstration of at least 50%
narrowing in a major cerebral or carotid artery, history of
non-embolic stroke, or previous surgery for such disease
Ventricular Function
• Previous MI, less than 6 hours
• Previous MI, 6 to 23 hours
• Previous MI, 1 to 7 days
24
One or more myocardial infarctions less than 6 hours before
intervention
One or more myocardial infarctions occurring 6 to 23 hours
before intervention
One or more myocardial infarctions occurring 1 to 7 days
before intervention
Criteria Used in Reporting Significant Risk Factors (1997) continued
Ventricular Function continued
• Ejection Fraction
• Malignant Ventricular Arrhythmia
Previous PCI
Two or Three Vessel Disease
Value of the ejection fraction taken closest to the
procedure. When a calculated measure is unavailable,
the Ejection Fraction should be estimated visually from
the ventriculogram or by echocardiography. Intraoperative
direct observation of the heart is not an adequate basis for a
visual estimate of the ejection fraction
Recent (within the past 7 days) recurrent ventricular
tachycardia or ventricular fibrillation requiring electrical
defibrillation or the use of intravenous antiarrhythmic
agents. Excludes a single episode of VT or VF occurring
in the early phase of an acute myocardial infarction and
responding well to treatment
The patient had one or more previous percutaneous
coronary interventions
Percent diameter stenosis is >70% in two or more vessels
or branches
25
MEDICAL TERMINOLOGY
percutaneous coronary intervention (PCI)
also known as angioplasty or percutaneous
transluminal coronary angioplasty – typically
in this procedure, a balloon catheter is threaded
up to the site of blockage in an artery in the heart,
and is then inflated to push arterial plaque against
the wall of the artery to create a wider channel in
the artery. Other procedures or devices (such as
atherectomies, stent or ultrasound) are sometimes
used in conjunction with the catheter to remove
plaque.
cardiovascular disease - disease of the heart and
blood vessels, the most common form of which is
coronary artery disease.
angina pectoris - the pain or discomfort felt
when blood and oxygen flow to the heart are
impeded by blockage in the coronary arteries.
This can also be caused by an arterial spasm.
lesion - an irregular growth of fiber and tissue.
Lesions of Type C are more problematic than
lesions of Type B, which in turn are more
dangerous than lesions of Type A.
arteriosclerosis - the group of diseases
characterized by thickening and loss of elasticity
of the arterial walls, popularly called “hardening
of the arteries”. Also called atherosclerotic
coronary artery disease or coronary artery disease.
myocardial infarction - partial destruction of the
heart muscle due to interrupted blood supply,
also called a heart attack or caused by coronary
thrombosis.
atherosclerosis - one form of arteriosclerosis in
which plaques or fatty deposits form in the inner
layer of the arteries.
Double, triple, quadruple bypass- the average
number of bypass grafts created during coronary
artery bypass graft surgery is three or four.
Generally, all significantly blocked arteries are
bypassed unless they enter areas of the heart
that are permanently damaged by previous heart
attacks. Five or more bypasses are occasionally
created. Multiple bypasses are often performed
to provide several alternate routes for the blood
flow and to improve the long-term success of the
procedure, not necessarily because the patient’s
condition is more severe.
cardiac catheterization - also known as
coronary angiography - a procedure for
diagnosing the condition of the heart and the
arteries connecting to it. A thin tube threaded
through an artery to the heart releases a dye,
which allows doctors to observe blockages with
an x-ray camera. This procedure is required
before PCI is performed.
26
coronary arteries - the arteries that supply
the heart muscle with blood. When they are
narrowed or blocked, blood and oxygen cannot
flow freely to the heart muscle or myocardium.
ischemic heart disease (ischemia) - heart
disease that occurs as a result of inadequate blood
supply to the heart muscle or myocardium.
plaque - also called atheroma, this is the fatty
deposit in the coronary artery that can block
blood flow.
risk factors for heart disease - certain risk
factors have been found to increase the
likelihood of developing heart disease. Some are
controllable or avoidable, and some cannot be
controlled. The biggest heart disease risk factors
are heredity, gender, and age, all of which cannot
be controlled. Men are much more likely to
develop heart disease than women before the age
of 55, although it is the number one killer of both
men and women. The risk increases with age, so
that half of all cases are in those who are over
75 years old.
Some controllable risk factors that contribute
to a higher likelihood of developing coronary
artery disease are high cholesterol levels, cigarette
smoking, high blood pressure (hypertension),
obesity, a sedentary lifestyle or lack of exercise,
diabetes, and poor stress management.
stenosis - the narrowing of an artery due to
blockage. Restenosis is when the narrowing recurs
after PCI or surgery.
27
Appendix 1
1997 RISK FACTORS FOR PCI IN-HOSPITAL MORTALITY (ALL CASES)
The significant pre-procedural risk factors for in-hospital mortality following PCI in 1997 are presented
in the table below.
Roughly speaking, the odds ratio for a risk factor represents the number of times more likely a patient
with that risk factor is of dying in the hospital during or after PCI than a patient without the risk factor, all
other risk factors being the same. For example, the odds ratio for the risk factor “diabetes” is 2.407. This
means that a patient with diabetes is approximately 2.407 times as likely to die in the hospital during or after
undergoing angioplasty as a patient without diabetes who has the same other significant risk factors.
For all risk factors in the table except age, ejection fraction and previous MI, there are only two
possibilities - having the risk factor or not having it. For example, a patient either has diabetes or does not
have it. In the case of the risk factor “Renal Failure on Dialysis”, the odds ratio given compares patients
who have renal failure and are on dialysis with all other patients (patients without renal failure and patients
with renal failure who are not on dialysis).
Previous MI is subdivided into four ranges (occurring less than 6 hours prior to the procedure, 6 through
23 hours prior, 1-7 days prior, and no MI within 7 days prior to the procedure). The last range, which
does not appear in the table below, is referred to as the reference category. The odds ratios for the
Previous MI ranges listed below are relative to patients who have had an MI more than 7 days prior to
PCI or who have not had a previous MI.
Ejection fraction, which is the percentage of blood in the heart's left ventricle that is expelled when it
contracts (with more denoting a healthier heart), is subdivided into three ranges (0-19%, 20-29%, and 30%
or more). The last range, which does not appear in the Appendix 1 table, is referred to as the reference
category. This means that the odds ratios that appear for the other ejection fraction categories in the table
are relative to patients with an ejection fraction of 30% or more. Thus, a PCI patient with an ejection
fraction of between 20% and 29% is about 2.968 times as likely to die in the hospital as a patient with an
ejection fraction of 30% or higher, all other significant risk factors being the same.
With regard to age, the odds ratio roughly represents the number of times more likely a patient who is over
age 60 is to die in the hospital than another patient who is one year younger, all other significant risk factors
being the same. Thus, a patient undergoing PCI who is 63 years old has a chance of dying in the hospital
that is approximately 1.087 times the chance that a patient 62 years old undergoing angioplasty has of dying
in the hospital, all other risk factors being the same. All patients under age 60 have roughly the same odds
of dying in the hospital if their other risk factors are identical.
28
Appendix 1 Multivariable Risk Factor Equation for Hospital Deaths During or Following PCI in New
York State – 1997 (All Cases)
Regression
Patient Risk Factor
Prevalence (%) Coefficient
P-Value
Odds Ratio
Demographic
Age >60
58.47
0.0831
<0.0001
1.087
Ventricular Function
Ejection Fraction 0-19%
0.68
1.8288
<0.0001
6.227
Ejection Fraction 20-29%
2.88
1.0878
<0.0001
2.968
Previous MI <6 hours
5.00
1.6769
<0.0001
5.349
Previous MI 6 – 23 hours
2.82
1.4589
<0.0001
4.301
Previous MI 1 – 7 days
15.72
0.7017
<0.0001
2.017
Comorbidities
Hemodynamic Instability
0.77
1.7277
<0.0001
5.628
Shock
0.44
2.9359
<0.0001
18.838
CPR
0.18
1.9811
<0.0001
7.251
Aortoiliac Disease
2.49
0.9618
<0.0001
2.616
Diabetes
22.46
0.8784
<0.0001
2.407
Renal Failure – on Dialysis
0.86
1.9772
<0.0001
7.222
Intercept = - 6.5832
C Statistic = 0.850
29
Appendix 2
1997 RISK FACTORS FOR IN-HOSPITAL MORTALITY FOR NON-EMERGENCY PCI
Appendix 2 contains the significant pre-procedural risk factors for 1997 New York PCI patients who were
not emergency patients, (were not in shock or hemodynamically unstable, did not undergo CPR immediately
prior to the procdure, and who did not suffer a heart attack within 24 hours prior to the PCI being
performed). In this table, age and renal failure on dialysis are to be interpreted in the same manner as
they were in Appendix 1. Ejection fraction is represented by only two groups (0% to 19% and 20% or
higher) in Appendix 2, with the chance of a patient with an ejection fraction of 0% to 19% dying in the
hospital being about 6.154 times as high as a patient with an ejection fraction of 20% or higher dying in the
hospital, all other risk factors being the same.
The odds ratios for “Two Vessels Diseased” and “Three Vessels Diseased" are relative to patients with a
single coronary artery diseased (“diseased” refers to blockage of 70% or more). Thus, patients with all three
of their coronary arteries diseased are about 3.308 times as likely to die in the hospital as patients with a
single diseased artery, all other risk factors being the same.
30
Appendix 2 Multivariable Risk Factor Equation for Hospital Deaths During or Following PCI in New
York State –1997 (Non-Emergency Patients Only)
Regression
Patient Risk Factor
Prevalence
Coefficient
P-Value
Odds Ratio
Demographic
Age >60
59.22
0.0667
<0.0001
1.069
Female Gender
32.48
0.5685
0.0013
1.766
Ventricular Function
Ejection Fraction 0 – 19%
Vessels Diseased
Two
Three
Renal Failure –On Dialysis
0.58
1.8171
<0.0001
6.154
28.21
15.39
1.0137
1.1963
<0.0001
<0.0001
2.756
3.308
0.88
2.0342
<0.0001
7.646
Intercept = - 6.8496
C Statistic = 0.758
31
Appendix 3
1995-1997 RISK FACTORS FOR PCI IN-HOSPITAL MORTALITY (ALL CASES)
The significant pre-procedural risk factors for in-hospital mortality following PCI in the 1995-1997 time
period are presented in the table below. The interpretation of this table is similar to the interpretation
of Appendix 1 that is described previously. With the exception of age, ejection fraction, vessels diseased,
previous myocardial infarction, worst lesion of Type C, and “risk squared”, the odds ratios for all risk factors
are relative to patients without the risk factor (e.g., patients with diabetes have odds of dying in the hospital
that are 2.805 times the odds of patients without diabetes dying in the hospital, all other risk factors being
the same). The interpretation of the ejection fraction categories is identical to that in Appendix 1, and the
interpretation of vessels diseased is exactly the same as in Appendix 2.
In this model, previous myocardial infarction (MI) or heart attack has been divided into three categories (MI
less than one day before the angioplasty, MI between one and seven days before the PCI and the reference
group – no MI within 7 days prior to the procedure). The odds ratios for the MI category in the table below
are relative to the reference group (heart attack more than seven days before the PCI or no previous heart
attack). The odds for patients who have a worst lesion of Type C, which is the worst type of lesion, are
relative to patients whose worst lesion is of Type A or Type B.
Age is represented by a linear and a quadratic (squared) term in order to improve the fit of the statistical
model, and in this form the odds ratios for the two terms are not meaningful in terms of characterizing
the relative risk of patients.
The “risk-squared” term is merely the square of the number of risk factors in Appendix 3 that a patient
has (not counting age, since everyone has an age), and is used to improve the ability of the model to
predict mortality.
32
Appendix 3 Multivariate Risk-Factor Equation for Hospital Deaths During or Following PCI in New
York State in 1995-1997 (All Cases).
Regression
Patient Risk Factor
Prevalence (%)
Coefficient
P-Value
Odds Ratio
Demographic
Age
–
-0.0486
0.1372
–
Age in years Squared
–
0.0759
0.0021
–
Female Gender
31.82
0.9808
<0.0001
2.667
Hemodynamic State
Unstable
1.03
2.1701
<0.0001
8.759
Shock
0.52
3.6496
<0.0001
38.461
Ventricular Function
Ejection Fraction 0-19%
0.60
1.9135
<0.0001
6.777
Ejection Fraction 20-29%
2.62
1.3295
<0.0001
3.779
Previous MI < 24 hours
7.56
1.9481
<0.0001
7.015
Previous MI 1-7 Days
15.16
1.0843
<0.0001
2.957
Severity of Atherosclerotic Process
Carotid/Cerebrovascular Disease
3.20
1.0003
<0.0001
2.719
Femoral/Popliteal Disease
3.80
1.0403
<0.0001
2.830
Comorbidities
Diabetes
20.91
1.0314
<0.0001
2.805
Malignant Ventricular Arrhythmia
1.83
1.5661
<0.0001
4.788
COPD
4.41
1.1719
<0.0001
3.228
Renal Failure, on Dialysis
0.80
2.4515
<0.0001
11.606
Vessels and Lesions
Two Vessels Diseased
27.21
0.8105
<0.0001
2.249
Three Vessels Diseased
13.56
1.1058
<0.0001
3.022
Worst Lesion Attempted is Type C
30.15
0.7646
<0.0001
2.148
Sum of Binary Risk Factors Squared
–
-0.0716
<0.0001
–
Intercept = - 7.1555
C Statistic =
0.869
33
Appendix 4
1995-1997 RISK FACTORS FOR IN-HOSPITAL MORTALITY FOR NON-EMERGENCY PCI
The significant pre-procedural risk factors for in-hospital mortality following non-emergency PCI in the
1995-1997 time period are presented in the Appendix 4 table below. As in Appendix 3, the interpretation of
this table is similar to the interpretation of Appendices 2 and 3 that are described previously.
The odds ratios for the ejection fraction groups are relative to patients with ejection fraction of 40% and
higher. Vessels diseased are interpreted as in Appendices 2 and 3, and the worst lesion of Type C is
interpreted as in Appendix 3. For “previous MI within 7 days”, the odds ratio is relative to patients with
a previous MI more than 7 days prior to their PCI or no previous heart attack. The odds ratio for age
is relative to a person one year younger.
Two new risk factors that appear in this model are body surface area and previous PCI. The odds ratio for
“previous PCI” is relative to patients who have not had an earlier PCI, and demonstrates that patients who
have had a previous PCI have odds of dying in the hospital that are only 0.596 times the odds of patients
who have not had a previous PCI, all other risk factors remaining the same. This finding is consistent
with various studies in the literature.
Body surface area is a function of height and weight, and is a proxy for vessel size. Since larger vessels
are easier to work with, the odds ratio for body surface area indicates that for each additional unit of body
surface area, the odds of dying in the hospital is only 0.367 times the odds for someone with a body surface
area one unit smaller, all other risk factors being the same.
Appendix 4 Multivariate Risk-Factor Equation for In-Hospital Deaths During or Following PCI in New
York State in 1995-1997 (Non-Emergency Cases).
Regression
Patient Risk Factor
Prevalence (%)
Coefficient
P-Value
Odds Ratio
Demographic
Age
–
0.0486
<0.0001
1.050
Female Gender
31.98
0.3726
0.0031
1.452
Body Surface Area
–
-1.0011
0.0004
0.367
Ventricular Function
Ejection Fraction 0-19%
0.50
1.9703
<0.0001
7.173
Ejection Fraction 20-29%
2.37
1.1803
<0.0001
3.255
Ejection Fraction 30-39%
6.32
0.4540
0.0087
1.575
Previous MI 1-7 Days
16.27
0.6176
<0.0001
1.854
Comorbidities
Diabetes
21.31
0.4797
<0.0001
1.616
Renal Failure, on Dialysis
0.81
1.9571
<0.0001
7.079
Vessels and Lesions
Two Vessels Diseased
27.12
0.6187
<0.0001
1.856
Three Vessels Diseased
13.52
0.7074
<0.0001
2.029
Worst Lesion Attempted is Type C
29.54
0.5617
<0.0001
1.754
Previous PCI
Intercept
C Statistic
34
28.04
= -7.6752
= 0.779
-0.5176
0.0003
0.596
Appendix 5
1995-1997 RISK FACTORS FOR IN-HOSPITAL MORTALITY FOR EMERGENCY PCI
The significant pre-procedural risk factors for in-hospital mortality following emergency PCI in the 1995-1997
time period are presented in the Appendix 5 table below. The odds ratio for age is relative to a person
one year younger, the odds ratio for ejection fraction less than 20% is relative to people with ejection
fractions of 20% and higher, and the odds ratio for three-vessel disease is relative to people with one
or two-vessel disease.
Also, since renal failure is expressed in terms of renal failure with dialysis and renal failure without dialysis,
the odds ratios are relative to people with no renal failure. Thus, PCI patients with renal failure who are
not on dialysis have odds of dying in the hospital that are 2.904 times the odds of PCI patients without renal
failure dying in the hospital, all other risk factors being the same.
Appendix 5 Multivariate Risk-Factor Equation for In-Hospital Deaths During or Following PCI in New
York State, 1995-1997 (Emergency Cases).
Regression
Patient Risk Factor
Prevalence (%)
Coefficient
P-Value
Odds Ratio
Demographic
Age
–
0.0522
<0.0001
1.054
Female Gender
29.95
0.4792
0.0002
1.615
Hemodynamic State
Unstable
12.75
0.9316
<0.0001
2.539
Shock
6.42
2.6746
<0.0001
14.507
Cardiopulmonary Resuscitation
0.84
1.1988
0.0017
3.316
Ventricular Function
Ejection Fraction 0-19%
1.72
0.9012
0.0010
2.463
Severity of Atherosclerotic Process
Carotid/Cerebrovascular Disease
2.67
0.8322
0.0006
2.298
Comorbidities
Diabetes
16.38
0.7385
<0.0001
2.093
Malignant Ventricular Arrhythmia
7.52
1.1662
<0.0001
3.210
Renal Failure, Creatinine > 2.5
1.48
1.0662
0.0008
2.904
Renal Failure, on Dialysis
0.72
1.1928
0.0061
3.296
Vessels and Lesions
Three Vessels Diseased
14.04
0.5862
<0.0001
1.797
Intercept
C Statistic
= -7.6597
= 0.883
35
36
Additional copies of this report may be obtained through the
Department of Health web site at http://www.health.state.ny.us
or by writing to:
Cardiac
Box 2000
New York State Department of Health
Albany, New York 12220
37
State of New York
George E. Pataki, Governor
Department of Health
Antonia C. Novello, M.D., M.P.H., Dr. P.H., Commissioner
07/01