P5491Gender differences in long-term outcomes and predictors of all-cause mortality after percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Conradie ◽  
E Chowdhury ◽  
A Whelan ◽  
S Worthley ◽  
T Rafter ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Female Gender ◽  
Coronary Intervention ◽  
Multivariate Logistic Regression ◽  
Female Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Background Gender disparities have been consistently reported in the nature, presentation, and treatment of coronary artery disease, leading to significant outcome differences. Previous reports have suggested that after adjusting for differing baseline and procedural characteristics female gender was an independent predictor of all-cause mortality after Percutaneous Coronary Intervention (PCI). We examined this issue using data from the Genesis Cardiovascular Outcomes Registry (GCOR). Methods We prospectively collected data on 10,989 PCI procedures from January 2009 to January 2018 from 12 Australian Hospitals, and compared the baseline patient and procedural characteristics and 1-year mortality by gender. Results Female patients were more likely than males to present with NSTEMI (23.0% vs. 21.1%, p=0.042), however less likely to have prior MI (19.5% vs. 24.2%, p<0.001) or PCI (28.8% vs 33.6%, p<0.001). Procedural success rates were similar between females and males (97.2%). On multivariate logistic regression, female gender had a higher rate of all cause mortality (OR 0.58, 95% CI 0.31 to 1.07; P=0.08) but similar rates of MACE (OR 0.84, 95% CI 0.55 to 1.07, P=0.42). Variables contributing to an increased risk of mortality in female patients, included a history of previous heart failure (OR 2.45, 95% CI 1.15 to 5.22; p=0.02), myocardial infarction (OR 2.06, 95% CI 1.09 to 3.90; p=0.026), and peripheral vascular disease (OR 2.69, 95% CI 1.32 to 5.47; p=0.006). Performing PCI to the LMCA significantly increased the risk of mortality in female patients (OR 3.84, 95% CI 1.14 to 12.9; p=0.029), and the use of BMS vs DES contributed to a worse outcome in women compared to men (OR 0.46, 95% CI 0.25 to 0.84; p=0.012). The presence of hypercholesterolaemia in women significantly increased the risk of mortality (OR 0.44, 95% CI 0.22 to 0.86; p=0.016). Multivariate logistic regression assessing 1-year outcome by gender for all-cause mortality, MACE, and unplanned admissions Outcome Male (vs female) Odds ratio 95% CI P-value Death (143) 0.58 0.31 to 1.07 0.08 MACE (334) 0.84 0.55 to 1.28 0.42 Unplanned readmission (888) 0.79 0.63 to 0.98 0.04 Conclusion Women have significant differences in baseline characteristics and increased all-cause mortality at 1 year compared to men, although overall MACE rates are similar. This study increases awareness of women at high risk, highlighting the need to improve the care of women undergoing PCI.

scholarly journals P0118ANEMIA AS A RISK FACTOR FOR CONTRAST-INDUCED NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Emna Chaabouni ◽  
Hela Jbali ◽  
Najjar Mariem ◽  
Mzoughi Khadija ◽  
Zouaghi Karim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Strong Predictor ◽  
Coronary Intervention ◽  
Severe Anemia ◽  
Contrast Induced Nephropathy ◽  
Female Patients ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Male Patients

Abstract Background and Aims Contrast-induced nephropathy is a potentially serious complication following coronary angiography and percutaneous coronary intervention . The association between severity of anemia and Contrast-induced nephropathy following coronary angiography is not well-established. In this prospective study, we aimed at assessing the association of anemia of various severity with the risk of Contrast-induced nephropathy in patients who underwent coronary angiography Method We prospectively enrolled 158 patients who underwent coronary angiography with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level &gt;25% or 0.5 mg/dL after 48 hours and anemia was defined as a value of Hb level ≤ 13 g/dl in male patients or ≤ 12 g/dl in female patients. Patients were stratified into three subgroups—mild (11.1 to 13.0 g/dL) in male patients and (11.1 to 12.0 g/dL) in female patients, moderate (9.1 to 11.0 g/dL) and severe anemia (7.0 to 9.0 g/dL). we used a multivariable logistic-regression model. Results 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent coronary angiography, 15 (9,5%) developed Contrast-induced nephropathy . Presence of anemia was associated with increased risk of developing Contrast-induced nephropathy (OR = 3.04, 95% confidence interval [CI] = 1.03 to 8.96, p= 0,043). Risk of Contrast-induced nephropathy was increasingly higher with increasing severity of the anemia; mild (OR = 1.67, 95% CI = 1.38 to 2.17, p=0,036), moderate (OR = 3.3, 95% CI = 0.61 to 10.6, p=0,028) .There was no patient with severe anemia. Conclusion In conclusion, severity of anemia is a strong predictor of CIN following coronary angiography.

Haematoma after Coronary Angiography and Percutaneous Coronary Intervention via the Femoral Artery Frequency and Risk Factors

2005 ◽  
Vol 4 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Kirsten Andersen ◽  
Marianne Bregendahl ◽  
Helen Kaestel ◽  
Mette Skriver ◽  
Jan Ravkilde
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Femoral Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Low Molecular Weight ◽  
Multivariate Logistic Regression ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Made In

Background: The most common complication after coronary angiography (CA) and percutaneous coronary intervention (PCI) is the development of haematoma. Several changes in procedures regarding CA and PCI have been made in our department in recent years. The aim of this audit is to establish how many patients develop haematoma after CA/PCI via the femoral artery and subsequently to find predictors that increase the risk of developing haematoma. Methods: We initially included 474 consecutive patients-322 patients undergoing CA and 141 patients undergoing PCI. Eleven patients were later excluded due to the absence of complete data. Thirty-three variables were registered in order to find predictors, which might increase the haematoma frequency. A univariate as well as a multivariate logistic regression analysis was performed. Results: Of the 463 patients, 6 patients developed a haematoma > 10 cm (1.3%) and 41 patients developed a haematoma > 5 cm (8.9%). The following factors were found to be associated with the generation of haematoma: Women, systolic blood pressure > 160 mm Hg, artery puncture > 1, sheath time > 16 min, ACT ≥ 175 s, Glycoprotein (GP) IIB/IIIa inhibitors, Low Molecular Weight Heparin before procedure, personnel change during compression, and anti-coagulant-treatment before procedure. Conclusions: The frequency of haematoma was 1.3% (> 10 cm) and 8.9% (> 5 cm), which corresponds with reports from similar studies and departments. The factors found to increase the risk of haematoma development can provide background for procedural changes and increase the focus on patients at increased risk in order to minimize the development of haematomas.

scholarly journals Percutaneous coronary intervention outcomes in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

Rheumatology ◽  
2020 ◽  
Vol 59 (9) ◽  
pp. 2512-2522 ◽  
Author(s):  
Sara C Martinez ◽  
Mohamed Mohamed ◽  
Jessica Potts ◽  
Abhishek Abhishek ◽  
Edward Roddy ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Lupus Erythematosus ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Autoimmune Rheumatic Disease ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease ◽  
National Perspective

Abstract Objective Patients with autoimmune rheumatic disease (AIRD) are at an increased risk of coronary artery disease. The present study sought to examine the prevalence and outcomes of AIRD patients undergoing percutaneous coronary intervention (PCI) from a national perspective. Methods All PCI-related hospitalizations recorded in the US National Inpatient Sample (2004–2014) were included, stratified into four groups: no AIRD, RA, SLE and SSc. We examined the prevalence of AIRD subtypes and assessed their association with in-hospital adverse events using multivariable logistic regression [odds ratios (OR) (95% CI)]. Results Patients with AIRD represented 1.4% (n = 90 469) of PCI hospitalizations. The prevalence of RA increased from 0.8% in 2004 to 1.4% in 2014, but other AIRD subtypes remained stable. In multivariable analysis, the adjusted odds ratio (aOR) of in-hospital complications [aOR any complication 1.13 (95% CI 1.01, 1.26), all-cause mortality 1.32 (1.03, 1.71), bleeding 1.50 (1.30, 1.74), stroke 1.36 (1.14, 1.62)] were significantly higher in patients with SSc compared with those without AIRD. There was no difference in complications between the SLE and RA groups and those without AIRD, except higher odds of bleeding in SLE patients [aOR 1.19 (95% CI 1.09, 1.29)] and reduced odds of all-cause mortality in RA patients [aOR 0.79 (95% CI 0.70, 0.88)]. Conclusion In a nationwide cohort of US hospitalizations, we demonstrate increased rates of all adverse clinical outcomes following PCI in people with SSc and increased bleeding in SLE. Management of such patients should involve a multiteam approach with rheumatologists.

scholarly journals Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

2019 ◽  
Vol 26 (12) ◽  
pp. 1273-1284 ◽  
Author(s):  
George CM Siontis ◽  
Mattia Branca ◽  
Patrick Serruys ◽  
Sigmund Silber ◽  
Lorenz Räber ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Cardiac Death ◽  
Coronary Intervention ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease

Aims To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and results Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40–49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75–3.28, p < 0.001) and 1.68 (95% confidence interval 1.34–2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). Conclusion Patients with reduced LVEF <40% or mid-range LVEF 40–49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.

scholarly journals Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiawen Li ◽  
Deshan Yuan ◽  
Lin Jiang ◽  
Xiaofang Tang ◽  
Jingjing Xu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Platelet Count ◽  
Leukocyte Count ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Inflammatory Biomarkers ◽  
Multivariate Logistic Regression ◽  
Percutaneous Coronary ◽  
Hs Crp

Background: Platelet reactivity is closely associated with adverse events in percutaneous coronary intervention (PCI) patients. Inflammation plays a crucial role in the development of coronary heart disease (CHD).Aim: To investigate the association of inflammatory biomarkers such as leukocyte count and high-sensitivity C reactive proteins (hs-CRP) with platelet reactivity in PCI patients treated with clopidogrel.Method: We examined 10,724 consecutive PCI patients in Fuwai hospital from January 2013 to December 2013. High on-treatment platelet reactivity (HTPR) was defined as adenosine diphosphate (ADP)-induced platelet maximum amplitude [MA(ADP)] of thromboelastogram (TEG) &gt; 47 mm, and low on-treatment platelet reactivity (LTPR) MA(ADP) &lt; 31 mm.Results: Finally, 6,772 PCI patients treated with clopidogrel who had the results of postoperative TEG were enrolled. Among them, 2,070 (30.57%) presented HTPR and 2,568 (37.92%) presented LTPR. As for LTPR, multivariate logistic regression showed that leukocyte count (OR: 1.153, 95% CI 1.117–1.191) and hs-CRP (OR: 0.920, 95% CI 0.905–0.936) were independent predictors, along with diabetes mellites, hemoglobin, platelet count and glucose. As for HTPR, multivariate logistic regression showed that leukocyte count (OR: 0.885, 95% CI 0.854–0.917) and hs-CRP (OR: 1.094, 95% CI 1.077–1.112) were independent predictors, along with sex, hemoglobin, platelet count and glucose.Conclusions: This was the first large real-world study reporting that both leukocyte count and hs-CRP were the independent factors for platelet reactivity in PCI populations treated with clopidogrel, among which higher leukocyte count was associated with more LTPR while higher hs-CRP was associated with more HTPR, providing new insights on individualized antiplatelet therapy.

scholarly journals Impact of nutritional index on contrast-associated acute kidney injury and mortality after percutaneous coronary intervention

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Miyeun Han ◽  
Hye Won Lee ◽  
Han Cheol Lee ◽  
Hyo Jin Kim ◽  
Eun Young Seong ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Nutritional Index ◽  
Increased Risk ◽  
Percutaneous Coronary

AbstractThe risk of malnutrition in acute kidney injury and mortality in coronary artery disease patients has not been studied. This study aimed to evaluate whether nutritional status assessed by Onodera’s prognostic nutritional index (PNI) was related to percutaneous coronary intervention (PCI) outcomes. A total of 3731 patients who received PCI between January 2010 and December 2018 were included. The relationship between PNI at the time of PCI and the occurrence of contrast-associated acute kidney injury (AKI) and all-cause death was evaluated using logistic regression and Cox proportional hazards models, respectively. AKI occurred in 271 patients (7.3%). A low PNI was independently associated with an increased risk of AKI on multivariate logistic regression analysis (OR 0.96, 95% CI 0.94–0.98, P = 0.001). During the median follow-up of 4.3 years, Kaplan–Meier analysis showed that patients with AKI/low PNI < 47.8 had a higher death rate. After adjusting for various risk factors, a low PNI was a significant risk factor for mortality (HR 0.98, CI 0.96–0.99, P = 0.003). A low level of PNI was associated with increased mortality, especially in the group aged over 70 years and female sex. PNI was closely associated with acute kidney outcomes and patient mortality after PCI.

Is female gender associated with worse outcomes after percutaneous coronary intervention of left main coronary artery?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W.J Skorupski ◽  
M Grygier ◽  
S Grajek ◽  
M Pyda ◽  
P Mitkowski ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Left Main Coronary Artery ◽  
Real Life ◽  
Female Gender ◽  
Coronary Intervention ◽  
Left Main ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Introduction Left main coronary artery (LM) disease is a life-threatening condition, so the invasive treatment is crucial for the survival of the patients. There is still controversy regarding whether female sex is associated with worse outcomes after percutaneous coronary intervention (PCI) of LM. Purpose Our aim was to examine gender-based differences in patients after LM PCI. Methods Consecutive 459 patients (mean age: 68.4±9.4 years) in whom PCI of LM was performed (between January 2015 and June 2018) were included in the study. The clinical and angiographic data of these patients including short and long-term outcomes has been analyzed. Results The whole group consisted of 112 (24.4%) women and 347 (75.6%) men. Compared with men, women were older (69.9±8.9 vs 67.9±9.5; p=0.04), had higher prevalence rates of diabetes (43.8% vs 33.4%; p=0.048) and hypertension (92% vs 79.1%; p&lt;0.01). Renal failure (42% vs 32.3%; p=0.061) was found insignificantly more often in women, frequency of other comorbidities did not differ statistically. Women were more often disqualified from bypass surgery (19.6% vs 11.8%; p=0.036) and more often required complex stenting techniques (29.2% vs 18.7%; p=0.028). SYNTAX Score and Euroscore II did not differ statistically between the genders. All periprocedural complications (8.9% vs 8.4%; p=0.85) and the frequency of periprocedural myocardial infarction (6.3% vs 4%; p=0.330) did not differ among the groups. We observed higher all-cause mortality in men group (19.1% vs 24.3%; p=0.041) at a median follow-up of 808 days (range 367 to 1616 days). Conclusion In our real-life cohort of patients, complex LM procedures and comorbidities were more frequent in women. There was no significant difference in short-term results between two genders, although in our real-life study we observed higher long-term all-cause mortality in men. Our results suggest that female gender in LM PCI is not a predictor of adverse outcomes. Further studies are required to determine the optimal revascularization modality in women. Long-term follow-up Funding Acknowledgement Type of funding source: None

Abstract 15121: Mortality in Cancer Patients Undergoing Percutaneous Coronary Intervention: Insights From a Hospital-based Cross-sectional Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anusha R Gaddam ◽  
Temitope Ajibawo ◽  
RIKINKUMAR PATEL
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Percutaneous Coronary

Introduction: Comorbid risk factors between cancer and coronary artery diseases (CAD) and underlying pathogenesis of inflammation and oxidative stress led to an increase in the number of cancer patients developing CAD. Hypothesis: The prime purpose of our hospital-based study is to evaluate the risk of mortality due to cancer and chronic comorbidities in post-percutaneous coronary intervention (PCI) patients. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS, 2012 to 2014) including 1,131,415 adult patients undergoing PCI with placement of non-drug and/or drug-eluting coronary artery stents. The logistic regression model was used to assess the odds ratio (OR) of the association between comorbid cancer and mortality in post-PCI hospitalized patients. Results: Most of the post-PCI patients with cancer were older adults (mean age 70.6 years), males (71.8%), and Caucasians (80.6%). Females (OR 1.28, 95% CI 1.24-1.34) had higher odds of post-PCI mortality risk compared to males. Among all comorbidities, coagulopathy and deficiency anemia were associated with increased risk of mortality by three times (95% CI 2.837-3.250) and 1.6 times (95% CI 1.534-1.692), respectively in post-PCI hospitalized patients. Comorbid cancer was associated with an increased risk of mortality in post-PCI hospitalized patients (OR 1.88, 95% CI 1.69-2.09) after controlling for potential confounders. Conclusions: Cancer is a significant risk factor increasing the risk of mortality by 88% in post-PCI hospitalized patients. An integrated care model requiring more vigilance and aggressive management for the complex patient population with cancer and other comorbidities are needed.

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