Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention

Kardiologiia ◽  
2020 ◽  
Vol 60 (9) ◽  
pp. 38-45
Author(s):  
M. V. Zykov ◽  
N. V. D’yachenko ◽  
O. A. Trubnikova ◽  
A. D. Erlih ◽  
V. V. Kashtalap ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Fold Increase ◽  
Female Gender ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Patients At Risk ◽  
Emergency Percutaneous Coronary Intervention

Aim        To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods        The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results   Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion            This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification. 

scholarly journals Risk stratification model for in-hospital death in patients undergoing percutaneous coronary intervention: a nationwide retrospective cohort study in Japan

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026683 ◽  
Author(s):  
Taku Inohara ◽  
Shun Kohsaka ◽  
Kyohei Yamaji ◽  
Hideki Ishii ◽  
Tetsuya Amano ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cohort Study ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Validation Cohort ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Risk Models ◽  
Percutaneous Coronary

ObjectivesTo provide an accurate adjustment for mortality in a benchmark, developing a risk prediction model from its own dataset is mandatory. We aimed to develop and validate a risk model predicting in-hospital mortality in a broad spectrum of Japanese patients after percutaneous coronary intervention (PCI).DesignA retrospective cohort study was conducted.SettingThe Japanese-PCI (J-PCI) registry includes a nationally representative retrospective sample of patients who underwent PCI and covers approximately 88% of all PCIs in Japan.ParticipantsOverall, 669 181 patients who underwent PCI between January 2014 and December 2016 in 1018 institutes.Main outcome measuresIn-hospital death.ResultsThe study population (n=669 181; mean (SD) age, 70.1(11.0) years; women, 24.0%) was divided into two groups: 50% of the sample was used for model derivation (n=334 591), while the remaining 50% was used for model validation (n=334 590). Using the derivation cohort, both ‘full’ and ‘preprocedure’ risk models were developed using logistic regression analysis. Using the validation cohort, the developed risk models were internally validated. The in-hospital mortality rate was 0.7%. The preprocedure model included age, sex, clinical presentation, previous PCI, previous coronary artery bypass grafting, hypertension, dyslipidaemia, smoking, renal dysfunction, dialysis, peripheral vascular disease, previous heart failure and cardiogenic shock. Angiographic information, such as the number of diseased vessel and location of the target lesion, was also included in the full model. Both models performed well in the entire validation cohort (C-indexes: 0.929 and 0.926 for full and preprocedure models, respectively) and among prespecified subgroups with good calibration, although both models underestimated the risk of mortality in high-risk patients with the elective procedure.ConclusionsThese simple models from a nationwide J-PCI registry, which is easily applicable in clinical practice and readily available directly at the patients’ presentation, are valid tools for preprocedural risk stratification of patients undergoing PCI in contemporary Japanese practice.

scholarly journals Echocardiographic Parameters as Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Miroslava Sladojevic ◽  
Srdjan Sladojevic ◽  
Dubravko Culibrk ◽  
Snezana Tadic ◽  
Robert Jung
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Right Ventricle ◽  
Validation Cohort ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Echocardiographic Parameters

Different ways have been used to stratify risk in acute coronary syndrome (ACS) patients. The aim of the study was to examine the usefulness of echocardiographic parameters as predictors of in-hospital outcome in patients with ACS after percutaneous coronary intervention (PCI). A data of 2030 patients with diagnosis of ACS hospitalized from December 2008 to December 2011 was used to develop a risk model based on echocardiographic parameters using the binary logistic regression. This model was independently evaluated in validation cohort prospectively (954 patients admitted during 2012). In-hospital mortality in derivation cohort was 7.73%, and 6.28% in validation cohort. Developed model has been designed with 4 independent echocardiographic predictors of in-hospital mortality: left ventricular ejection fraction (LVEF RR=0.892; 95%CI=0.854–0.932,P<0.0005), aortic leaflet separation diameter (AOvs RR=0.131; 95%CI=0.027–0.627,P=0.011), right ventricle diameter (RV RR=2.675; 95%CI=1.109–6.448,P=0.028) and right ventricle systolic pressure (RVSP RR=1.036; 95%CI=1.000–1.074,P=0.048). Model has good prognostic accuracy (AUROC=0.84) and it retains good (AUROC=0.78) when testing on the validation cohort. Risks for in-hospital mortality after PCI in ACS patients using echocardiographic measurements could be accurately predicted in contemporary practice. Incorporation of such developed model should facilitate research, clinical decisions, and optimizing treatment strategy in selected high risk ACS patients.

scholarly journals Impact of Thrombocytopenia on In-Hospital Outcome in Patients Undergoing Percutaneous Coronary Intervention

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Zhongxiu Chen ◽  
Zheng Liu ◽  
Nan Li ◽  
Ran Liu ◽  
Miye Wang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Count ◽  
Major Bleeding ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Hospital Inpatient ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background. Thrombocytopenia was intuitively considered to be associated with higher risk of bleeding and multiple comorbidities after percutaneous coronary intervention (PCI). However, controversial results exist, and the real-world clinical impact of thrombocytopenia in patients undergoing PCI is largely unknown. The aim of this study was to evaluate the influence of baseline thrombocytopenia on the prognosis of patients undergoing PCI. Methods. Using the West China Hospital Inpatient Sample database, patients who underwent PCI were identified from August 2012 to January 2019. Baseline thrombocytopenia was defined as a preprocedural platelet count of 100 × 10 9 / L or less obtained from a routine blood sample taken within 48 hours before coronary PCI. The clinical effect of the advanced thrombocytopenia group ( ≤ 85 × 10 9 / L ), according to the median value of platelet count in the thrombocytopenia cohort, was further assessed. The primary outcome was a composite of in-hospital death, bleeding events, and post-PCI transfusion. Results. Of 9531 patients enrolled in our study, 936 had baseline thrombocytopenia and 8595 patients did not have. There were no significant differences in the primary outcome between the two groups. However, advanced thrombocytopenia was independently associated with higher risk of primary outcome (OR 1.67, 95% CI 1.06 to 2.65, p = 0.029 ). Acute coronary syndrome (ACS) patients with thrombocytopenia were associated with higher odds of major bleeding ( BARC ≥ 2 ) (OR 2.56, 95% CI 1.24 to 5.44, p = 0.011 ). Compared with the nonthrombocytopenia group, the thrombocytopenia group with ticagrelor use had higher odds of major bleeding (OR 9.7, 95% CI 1.57 to 60.4 versus OR 0.22, 95% CI 0.03 to 1.69, interaction p = 0.025 ). Conclusions. It seems feasible for patients with thrombocytopenia to receive PCI, but close attention should be paid to advanced thrombocytopenia, the risk of postprocedure bleeding in ACS patients, and the use of more potent P2Y12 inhibitor.

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