OR01-3
A Multicenter Predictive Model for Clinically Meaningful Adverse Events in Pediatric Patients Undergoing Transcatheter Pulmonary Vein Interventions
Brian Quinn, M.D., Boston Children's Hospital, Dedham, MA
Mirjam L Keochakian, MS, Boston Children's Hospoital, Boston, MA, Oliver M Barry, MD, FSCAI, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, Brian A Boe, M.D., Joe DiMaggio Children's Hospital, Hollywood, FL, Abhay A. Divekar, M.D., FSCAI, Children's Medical Center of Dallas, Irving, TX, Lindsay F Eilers, MD, Texas Children's Hospital, Houston, TX, Susan R. Foerster, M.D., FSCAI, Children's Wisconsin, Milwaukee, WI, Kimberlee Gauvreau, ScD, Boston Children's Hospital, Boston, MA, Jonathon Hagel, MD, FSCAI, C.S. Mott Children's Hospital, Ann Arbor, MI, Michael Hainstock, M.D., The University of Virginia, Charlottesville, VA, Ralf J. Holzer, M.D., MSc, FSCAI, The University of California, Davis, Sacramento, CA, Henri Justino, M.D., FSCAI, Rady Children's Hospital, San Diego, CA, Amr Matoq, M.D., Cincinnati Children's Hospital Medical Center, Cincinnati, OH, George T. Nicholson, M.D., Vanderbilt University, Nashville, TN, Michael Liam O'Byrne, M.D., FSCAI, Children's Hospital of Philadelphia, Philadelphia, PA, Toby A. Rockefeller, M.D., FSCAI, Children's Mercy - Kansas City, Kansas City, MO, Arash Salavitabar, M.D., FSCAI, Nationwide Children's Hospital, Columbus, OH, Patcharapong Suntharos, M.D., FSCAI, Cleveland Clinic Children's, Cleveland, OH, Sara M. Trucco, M.D., FSCAI, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, Jenny E. Zablah, M.D., FSCAI, University of Colorado Anschutz Medical Campus, Aurora, CO, Dominic Zanaboni, M.D., Washington University School of Medicine St. Louis, St. Louis, MO, Ryan M. Callahan, M.D., FSCAI, Children's Hospital of Philadelphia, Wayne, PA and Brian Quinn, M.D., Boston Children's Hospital, Dedham, MA
Keywords: Congenital Heart Disease (CHD) and Quality
Background:
Pulmonary vein stenosis (PVS) in pediatric patients, a condition requiring frequent transcatheter palliative interventions with high morbidity and mortality, necessitates development of a multicenter predictive model for clinically meaningful adverse events (CMAE).
Methods:
Patient and procedural data were collected for Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry cases with PVS interventions aged ≤18 years from 1/1/19 - 12/31/22. A multivariable logistic regression model predicting the primary outcome CMAE (severity levels 3bc/4/5) was built using a random sample of 75% of cases and validated with the remaining 25%. Model discrimination was assessed using the c-statistic and calibration using the Hosmer-Lemeshow test.
Results:
The derivation dataset of 716 patients had an overall CMAE rate of 7.8%. Patient and procedural characteristics considered for model inclusion are shown in Table 1. The final multivariable model included male sex (odds ratio [OR] 1.74), genetic syndrome (OR 1.99), admission source (OR for medical unit 2.28; OR for step-down unit or ICU 2.07), case duration (OR for 120-209 minutes 2.05, OR for ≥210 minutes 3.18), and hemodynamic vulnerability score (OR for 1 point = 2.05, 2 points = 4.41, ≥3 points = 3.44). C-statistic 0.75, Hosmer-Lemeshow test p = 0.57.
Conclusions:
Important predictive features include hemodynamic vulnerability score, case duration as a marker for procedural complexity and admission source. Improved understanding of risk and future use of predictive modeling may allow for development of risk mitigation strategies to improve outcomes. 