Percutaneous Coronary Intervention in Patients With End-Stage Liver Disease

Singh, Vikas; Patel, Nileshkumar; Rodriguez, Alex P.; Shantha, Ghanshyam; Arora, Shilpkumar; Deshmukh, Abhishek; Cohen, Mauricio G.; Grines, Cindy L.; Marchena, Eduardo de; Badheka, Apurva; Ghatak, Abhijit

doi:10.1016/j.amjcard.2016.03.010

Cited by 29 publications

(50 citation statements)

References 24 publications

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“…Finally, bleeding complications were identified, including gastrointestinal, retroperitoneal, intracranial, intracerebral haemorrhage, unspecified haemorrhage, and whether a blood transfusion was required. Complications were identified by ICD-9-CM codes in any secondary diagnosis field (DX2-DX30) or through any procedural code on the record (S3 Table) [20]. …”

Section: Methods and Resultsmentioning

confidence: 99%

Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States

et al. 2018

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BackgroundPrior studies have reported inconsistencies in the baseline risk profile, comorbidity burden and their association with clinical outcomes in women compared to men. More importantly, there is limited data around the sex differences and how these have changed over time in contemporary percutaneous coronary intervention (PCI) practice.Methods and resultsWe used the Nationwide Inpatient Sample to identify all PCI procedures based on ICD-9 procedure codes in the United States between 2004–2014 in adult patients. Descriptive statistics were used to describe sex-based differences in baseline characteristics and comorbidity burden of patients. Multivariable logistic regressions were used to investigate the association between these differences and in-hospital mortality, complications, length of stay and total hospital charges. Among 6,601,526 patients, 66% were men and 33% were women. Women were more likely to be admitted with diagnosis of NSTEMI (non-ST elevation acute myocardial infarction), were on average 5 years older (median age 68 compared to 63) and had higher burden of comorbidity defined by Charlson score ≥3. Women also had higher in-hospital crude mortality (2.0% vs 1.4%) and any complications compared to men (11.1% vs 7.0%). These trends persisted in our adjusted analyses where women had a significant increase in the odds of in-hospital mortality men (OR 1.20 (95% CI 1.16,1.23) and major bleeding (OR 1.81 (95% CI 1.77,1.86).ConclusionIn this national unselected contemporary PCI cohort, there are significant sex-based differences in presentation, baseline characteristics and comorbidity burden. These differences do not fully account for the higher in-hospital mortality and procedural complications observed in women.

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Section: Methods and Resultsmentioning

confidence: 99%

Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States

et al. 2018

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“…Prior studies assessing in-hospital and short-term outcomes of PCI in cirrhotics show increased hemorrhagic and transfusion rates of 7% to 15%. 1,18 In our study, long-term bleeding rates during up to 1-year follow-up were greater, with a 46% rate of combined major and minor bleeding events. Moreover, bleeding risk increased (40%) even without PCI in patients with cirrhosis given their coagulopathy and portal hypertension.…”

Section: Discussionmentioning

confidence: 40%

“…The safety and efficacy of PCI in the cirrhotic population are not well known, and there are currently no clear hepatology or transplant practice guidelines addressing revascularization. While a few retrospective studies investigating the safety and short-term/in-hospital outcomes of PCI in cirrhotics have been reported, 1,4,[18][19][20] long-term outcome data are scant. Furthermore, the incidence of bleeding attributable to PCI and antiplatelet therapy, acute renal failure, and outcomes of patients who receive transplant following PCI remain poorly characterized.…”

Section: Clinical Medicine Insights: Cardiologymentioning

confidence: 99%

“…Patients with cirrhosis or end-stage liver disease often have coexisting coronary artery disease (CAD) with a similar or higher prevalence than the general population. [1][2][3][4][5][6][7] Individuals with pre-cirrhotic pathology, particularly nonalcoholic steatohepatitis (NASH) or nonalcoholic fatty liver disease (NAFLD), also have an elevated risk of developing CAD. 8,9 When an indication for coronary revascularization arises, patients with advanced liver disease are often deemed poor surgical revascularization candidates given their risk of death, post-operative liver failure, and/or bleeding, and thus they are often referred for high-risk percutaneous coronary intervention (PCI).…”

Section: Introductionmentioning

confidence: 99%

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One-Year Outcomes of Percutaneous Coronary Intervention in Patients with End-Stage Liver Disease

Saybolt

Kiss

et al. 2020

Clin Med Insights Cardiol

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Background: Patients with cirrhosis and coronary artery disease (CAD) are at high risk for morbidity during surgical revascularization so they are often referred for complex percutaneous coronary intervention (PCI). Percutaneous coronary intervention in the cirrhotic population also has inherent risks; however, quantifiable data on long-term outcomes are lacking. Methods: Patients with angiographically significant CAD and cirrhosis were identified from the catheterization lab databases of the University of Pennsylvania Health System between 2007 and 2015. Outcomes were obtained from the medical record and telephonic contact with patients/families. Results: Percutaneous coronary intervention was successfully performed in 42 patients (51 PCIs). Twenty-nine patients with significant CAD were managed medically (36 angiograms). The primary outcome (a composite of mortality, subsequent revascularization, and myocardial infarction) was not significantly different between the 2 groups during a follow-up period at 1 year (PCI: 50%, Control: 40%, P = .383). In the PCI group, a composite adverse outcome rate that included acute kidney injury (AKI), severe bleed, and peri-procedural stroke was elevated (40%), with severe bleeding occurring after 23% of PCI events and post-procedural AKI occurring after 26% of events. The medical management group had significantly fewer total matched adverse outcomes (17% vs 40% in the PCI group, P = .03), with severe bleeding occurring after 11% of events and AKI occurring after 6% of events. Increased risk of adverse events following PCI was associated with severity of liver disease by Child-Pugh class. Conclusions: Percutaneous coronary intervention in patients with cirrhosis is associated with an elevated risk of adverse events, including severe bleeding and AKI.

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“…We used the Elixhauser comorbidity variables and the paralysis variable from Elixhauser comorbidities as a surrogate for hemiplegia and the connective tissue disease and leukemia from the CCS codes 210, 211 & 39 respectively to calculate the CCI. The continuous CCI score was then categorized into comorbidity groups with CCI score of 0, 1, 2 and ≥3 27 . Patients were excluded if they died during index PCI, discharged during the month of December and had a planned readmission within 30 days.…”

Section: Methodsmentioning

confidence: 99%

Effect of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database)

Kwok

Martinez

Pancholy

et al. 2018

Sci Rep

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It is unclear how comorbidity influences rates and causes of unplanned readmissions following percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database who were admitted to hospital between 2010 and 2014. The comorbidity burden as defined by the Charlson Comorbidity Index (CCI). Primary outcomes were 30-day readmission rates and causes of readmission according to comorbidity burden. A total of 2,294,346 PCI procedures were included the analysis. The patients in CCI = 0, 1, 2 and ≥3 were 842,272(36.7%), 701,476(30.6%), 347,537(15.1%) and 403,061(17.6%), respectively. 219,227(9.6%) had an unplanned readmission within 30 days and rates by CCI group were 6.6%, 8.6%, 11.4% and 15.9% for CCI groups 0, 1, 2 and ≥3, respectively. The CCI score was also associated with greater cost (cost of index PCI for not readmitted vs readmitted was CCI = 0 $21,257 vs $19,764 and CCI ≥ 3 $26,736 vs $27,723). Compared to patients with CCI = 0, greater CCI score was associated with greater independent odds of readmission (CCI = 1 OR 1.25(1.22–1.28), p < 0.001, CCI ≥ 3 OR 2.08(2.03–2.14), p < 0.001). Rates of non-cardiac causes for readmissions increased with increasing CCI group from 49.4% in CCI = 0 to 57.1% in CCI ≥ 3. Rates of early unplanned readmission increase with greater comorbidity burden and non-cardiac readmissions are higher among more comorbid patients.

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Percutaneous Coronary Intervention in Patients With End-Stage Liver Disease

Cited by 29 publications

References 24 publications

Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States

Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States

One-Year Outcomes of Percutaneous Coronary Intervention in Patients with End-Stage Liver Disease

Effect of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database)

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