The Mass-DAC exceptional risk criteria were developed by a committee of Massachusetts interventionalists. The intent of the exceptional risk designation is to categorize rare uniquely high risk cases, with high potential patient benefit, in which the predictors of risk are not included in the current Mass-DAC risk adjustment model. The risk of in-hospital mortality can be based on anatomical or clinical considerations, but will typically involve a second, acutely life-threatening condition for which PCI is urgently required in order to allow continued treatment. It is expected that nearly all exceptional risk cases will involve severe time pressure in order to make a therapeutic decision (such as the need to treat STEMI in a patient with a second severe medical co morbidity) and that elective/urgent cases will rarely qualify for exceptional risk designation.
An exceptional use case will be considered for review if the operator or institution believes that the case in question meets the following two criteria:
- Extremely high risk features not captured by current risk adjustment covariates.
- PCI was the “best” or only option for improving chance for survival.
All PCI cases submitted as exceptional risk require additional documentation and are reviewed by the exceptional risk committee.
The criteria details, committee protocols, and a series of cases studies are available as pdf file downloads below.