A longitudinal monitoring study of cardiovascular health in the Essex region

This thesis investigates the risk factors associated with adverse outcomes following percutaneous coronary intervention (PCI) for patients reporting to the Essex Cardiothoracic Centre (ECTC). The risk prediction model NWQIP (North West Quality Improvement Programme), for in-hospital Major Adverse Cardiac Events (MACE), comprising of at least one of four types of event (Q-wave myocardial infarction, death, emergency coronary artery bypass graft surgery, and cerebrovascular accidents), was externally validated on the ECTC PCI procedure database, using data from 2007 to 2015, to evaluate its effectiveness in a different era of stenting and a different geographical location. It was found the NWQIP model requires recalibration and hence no longer predicts such MACE events accurately. A custom risk prediction model was designed for the outcome of 30-day mortality. This incorporates novel risk factors (pre-operation ventilation and peripheral vascular disease) that were not featured in the NWQIP model. A subsequent analysis was performed on stable (elective) patients to identify those that are likely to either die or require a subsequent coronary revascularisation within three years. These two novel risk models should be tested on PCI cohorts external to the ECTC to identify how effective they are, and if they perform well, then possibly adopted into modern PCI practice for usage by consultants, operators, or patients for informed consent.