In-hospital outcomes after percutaneous coronary interventions in cardiac allograft recipients

Abstract

Introduction: The average age and survival of heart transplant recipients have improved significantly over the last 10 years. In these long-term survivors, coronary allograft vasculopathy is one of the most common causes of death. There is a paucity of large-data research highlighting the short-term outcomes of percutaneous coronary interventions in cardiac allograft recipients. Methods: We compared the in-hospital outcomes of heart transplant recipient and non-transplant recipients following percutaneous coronary intervention using data from the National inpatient sample (NIS). All adult patients (age ⩾ 18 years) who had percutaneous coronary intervention in the index admissions from January of 2005 to December of 2014 were included in the analysis. They were then divided into two groups based on their heart transplant status. The primary outcome was in-hospital mortality. Secondary outcomes were stroke, cardiac arrest, duration of hospitalization, and total hospital charges. Logistic regression models were used to compare in-hospital outcomes between the two groups. Results: Of 1,316,528 patients who had percutaneous coronary intervention, 618 (0.05%) were heart transplant recipients and 1,315,910 (99.95%) were not. The heart transplant recipient group was significantly younger with lower rates of obesity and peripheral vascular disease but higher rate of chronic kidney disease, iron deficiency anemia, and chronic liver disease. There was significantly higher in-hospital mortality in transplant recipients below 65 years of age (adjusted odds ration = 2.3, p value < 0.0001). Subjects in the heart transplant recipient group also had longer hospital stays ( p value = 0.002). Conclusion: Heart transplant recipients younger than 65 years had higher in-hospital mortality. Subjects in the heart transplant recipient group were also younger and had longer duration of hospitalization than the non-transplant cohorts.

Coronary Artery Revascularization in Heart Transplant Patients: A Systematic Review and Meta-Analysis

“…Twenty-four studies were included that investigated the outcomes of HTx recipients undergoing revascularization with a total of 8,448,035 patients, of which 6,194 underwent HTx. Of note, two studies comprise the majority of the overall patient population, including 8,441,886 patients, 8,439,680 of which were not transplant recipients and were used as controls [21, 22]. Of the 6,194 HTx recipients included in this study, 5,047 received revascularization for CAV in the form of PCI with BMS or DESs, or CABG.…”

“…Post-procedural stroke was reported in 5 studies and ranged from 0.0 to 4.83% for patients undergoing PCI [21, 27, 33, 34]. A significant difference was identified between BMS and DES in 1 study with 4.83% and 1.63% ( p = 0.0288), respectively, experiencing a postoperative stroke [33].…”

“…Data collection dates ranged from 1995 to 2019. Primarily, retrospective studies were found during the literature search and included in this review [21‒44].…”

“…Ten studies reported in-hospital mortality, 2 with HTx patients undergoing CABG and 11 with patients undergoing PCI [21‒23, 27, 31, 33, 34, 40, 42‒44]. In-hospital mortality was 0.0% for CABG and 0.0–8.34% for PCI.…”

“…Acute Kidney Injury AKI was reported in 3 studies with 1 study finding higher rates of AKI post-PCI in patients with a HTx (17.37%) when compared to those without (5.69%) (p < 0.0001) [21,27,33].…”