scholarly journals Percutaneous Coronary Intervention Outcomes in Solid Organ Transplant Candidates

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Kate L. Harris, BS ◽  
Kyle Frick, MD ◽  
Lawrence Lee, MD
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
Organ Transplant ◽  
Coronary Intervention ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Percutaneous Coronary ◽  
Transplant Evaluation ◽  
End Stage

Background: As part of the pre-transplant assessment, patients with end-stage renal, liver, pancreas, or lung disease who wish to attain transplant eligibility must undergo evaluation for coronary artery disease (CAD). Any significant CAD must be treated, usually by revascularization via either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), in order to achieve transplant candidacy. PCI in these patients is inherently higher risk due to baseline comorbidities, but there are few studies reporting outcomes following PCI in this population. We sought to investigate the short- and intermediate-term outcomes in patients undergoing PCI as part of a transplant candidacy evaluation. We also aimed to assess whether these patients ultimately received the desired transplant after PCI. Methods: This is a retrospective study investigating all patients who underwent PCI as part of a pre-transplant evaluation between 2009 and 2017 at IU Health Methodist Hospital. Patients were identified and data variables were extracted from an institutional American College of Cardiology CathPCI database. Medical records of all patients were reviewed to determine date of initial PCI and the type of solid organ transplant each patient was being evaluated for. Primary outcomes measured included 30-day and 1-year mortality, and whether organ transplantation ultimately occurred. Results: A total of 497 patients were identified. Pre-transplant PCI performed in end-stage liver disease was most common (n=182), followed by renal (n=167), lung (n=74), multi-organ (n=66), pancreas (n=6), and intestinal (n=2). Combined 30-day mortality was 4.9%, 5.4%, 12.2%, 0%, 0%, and 0% for liver, renal, lung, multi-organ, pancreas, and intestinal, respectively. Combined 1-year mortality was 23.1%, 7.8%, 12.2%, 37.9%, 0%, and 0% for liver, renal, lung, multi-organ, pancreas, and intestinal, respectively. The percentage of patients ultimately receiving the desired transplant was low, with 32.4% for liver, 35.9% for renal, 32.4% for lung, 57.6% for multiorgan, 83.3% for pancreas, and 0% for intestinal. Conclusion: This study demonstrates that PCI in patients undergoing solid organ transplant evaluation is relatively high-risk based on the 30-day and 1-year mortality. Furthermore, the percentage of patients ultimately receiving a transplant is relatively low. These results raise the question of whether high-risk PCI is the optimal CAD treatment in this population. These results also raise the question of whether changes to the transplant care protocol should be made to improve the likelihood of receiving a transplant before continuing to subject these patients to high-risk PCI.

P1577Incidence, etiologies and predictors of 30-day readmission after percutaneous coronary intervention in end-stage renal disease patients; Analysis from national readmission database

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Hassan ◽  
C Krittanawong ◽  
S Jazner ◽  
J Rangaswami ◽  
B Bozorgnia ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
End Stage Renal Disease ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
National Readmission Database

Abstract Background End stage renal disease (ESRD) is a known risk factor for coronary artery disease (CAD). The association of ESRD with short-term readmissions after percutaneous coronary intervention (PCI) has not been well studied. Purpose This study aims to examine he 30-day readmission rate, predictors of readmission and etiologies of readmission in ESRD patients after PCI. Methods and results The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in ESRD patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. Results We evaluated 96,869 hospitalized patients who survived to discharge after PCI from January through November 2014 and analyzed unplanned readmissions over 30 days after discharge. A total of 11,624 patients (12%) were readmitted within 30 days. Among the readmitted patients, majority of readmissions were due to non-cardiac causes. Nineteen percent had congestive heart failure (HF), 11% had PCI, 2% had coronary artery bypass surgery, and 1.5% died during the readmission. Acute respiratory failure (21%) and infections (14%) compromised majority of non-cardiac causes. Predictors of increased readmissions were female sex (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01- 1.0, p<0.001), infections (OR 2.06, 95% CI 1.44–2.4, p<0.001), diabetes (OR 1.91, 95% CI 1.07–2.63, P<0.001), chronic lung disease (OR 3.16, 95% CI 2.11–4.2, p<0.001), chronic liver disease (OR 1.96, 95% CI 1.1–2.23, p<0.001), acute HF (OR 1.17, 95% CI 1.12–1.22, p<0.001) and anemia (OR 1.09, 95% CI 1.06–1.13, p<0.001). Conclusion ESRD patients are at high risk of 30-day readmissions after PCI. Although majority of patients are readmitted with non-cardiac causes, HF and repeat PCI were the most common cardiac etiologies of readmissions. Female sex, infections, chronic liver and lung diseases are independently associated with high risk of 30-day readmission in ESRD patients after PCI. Acknowledgement/Funding None

scholarly journals Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Ahmad Shoaib ◽  
Muhammad Rashid ◽  
Evangelos Kontopantelis ◽  
Andrew Sharp ◽  
Eoin F. Fahy ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Percutaneous Coronary

Background: Patients with complex high-risk coronary anatomy, such as those with a last remaining patent vessel (LRPV), are increasingly revascularized with percutaneous coronary intervention (PCI) in contemporary practice. There are limited data on the outcomes of these high-risk procedures. Methods: We analyzed a large longitudinal PCI cohort (2007–2014, n=501 841) from the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing patients into 2 groups; LRPV group (n=2432) and all other PCI groups (n=506 691). Results: Patients in the LRPV PCI group were older, had more comorbidities, and higher prevalence of moderate-severe left ventricular systolic dysfunction. Mortality was higher in the LRPV PCI group during hospital admission (12 % versus 1.5 %, P <0.001), at 30 days (15% versus 2%, P <0.001), and at one-year (24% versus 5%, P <0.001). In a propensity score matching analysis the adjusted risk of mortality during index admission (odds ratio, 2.05 [95% CI, 1.65–2.44], P <0.001), at 30 days (odds ratio, 2.13 [95% CI, 1.78–2.5], P <0.001), at 1 year (odds ratio, 1.81 [95% CI, 1.59–2.03], P <0.001), and in-hospital major adverse cardiovascular events (odds ratio, 1.8 [95% CI, 1.42–2.19], P <0.001) were higher in LRPV PCI group as compared to control group. In sensitivity analyses, similar clinical outcomes were observed irrespective of which major epicardial coronary artery was treated. Conclusions: In this contemporary cohort, patients who had PCI to their LRPV had a higher-risk profile and more adverse clinical outcomes, irrespective of the vessel treated.

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