Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study)

Abstract

Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors.

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

“…Capture of a wide range of comorbid conditions enabling calculation of comorbid burden through the CCI score in the NIS represented a robust objective attempt for comorbidity analysis, although frailty, per se, that is known to associate with poorer outcomes is not captured in this dataset, and is likely to be more prevalent in females who were on average 5 years older than men. Whilst the Charlson score is the most widely used measure of comorbid burden in the literature and has been shown to have an independent prognostic impact on both in-hospital and post discharge outcomes [33], systematic differences in comorbid prevalence between men and women not captured by the Charlson score may bias outcomes. Previous work has suggested that women are less likely to be offered invasive therapy in acute coronary syndromes than men [34] which may lead to imbalances in the risk profile of patients particularly in the ACS setting.…”

Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation

“…Moreover, many of the co-morbidities used in the development of CPMs are cardiovascular risk factors, with important non-cardiovascular co-morbidities not considered 30 . In particular, frailty is not reflected in many of the CPMs, despite being particularly prevalent in elderly patients with aortic stenosis and previous work suggesting frailty to be associated with poor TAVI outcomes 31., 32..…”

Meta-Analysis of the Prognostic Impact of Anemia in Patients Undergoing Percutaneous Coronary Intervention

“…Finally anaemia may merely be a marker of a greater co-morbid in frailer patients, and the statistical models may have been affected by incomplete adjustments for confounders such as co-morbid burden or frailty. Our previous work has shown that co-morbidity burden is significant in patients undergoing PCI and is independently associated with adverse shorter and longer-term clinical outcomes (35).…”