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Impact of cardiac catheterization-percutaneous coronary intervention timing on inhospital mortality
Carol L Goldstein1, Michael Racz, Edward L Hannan
1School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA.
Insights
Performing percutaneous coronary interventions (PCIs) during the same catheterization procedure is as safe as staged procedures for most patients. However, high-risk patients, particularly those with heart failure, may face increased mortality risks with combined procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Percutaneous coronary interventions (PCIs) are often performed after initial catheterization for convenience and cost-effectiveness.
- Previous studies on the safety of same-admission PCI timing were limited by small sample sizes and inadequate patient stratification.
Purpose of the Study:
- To compare in-hospital mortality between combined (same-session) and staged (separate sessions within the same admission) percutaneous coronary interventions.
- To identify patient subgroups that may experience different outcomes based on PCI timing.
Main Methods:
- Utilized data from New York's PCI registry to develop a predictive model for in-hospital mortality.
- Compared mortality rates between combined and staged PCI procedures after adjusting for preprocedural patient risk factors.
Main Results:
- Overall, no significant difference in in-hospital mortality was observed between combined and staged PCI procedures after risk adjustment (OR 1.14, P =.38).
- However, high-risk patients with congestive heart failure or Canadian Cardiovascular Society class IV symptoms undergoing combined procedures showed significantly higher mortality odds compared to those undergoing staged procedures (OR = 1.59, P =.04 and OR = 1.64, P =.04, respectively).
Conclusions:
- Combined percutaneous coronary interventions demonstrate comparable average mortality rates to staged procedures.
- Combined procedures may be less suitable for certain high-risk patient populations, necessitating careful consideration of individual risk factors.
Background:
It is more convenient and less costly to perform percutaneous coronary interventions (PCIs) in the catheterization laboratory after catheterization, but there is some doubt as to whether it is harmful to patients. Other studies on this topic have been hampered by small sample sizes and an inability to separate patients who underwent PCI after catheterization in the same admission from patients who underwent PCI in a subsequent admission.
Methods:
Data from New York's PCI registry were used to develop a statistical model that predicted inhospital mortality based on preprocedural patient characteristics and the timing of the PCI (at same time as catheterization [combined procedure] or in the same admission as catheterization, but not at the same time [staged procedure]). The difference in mortality for the timing options was compared after adjusting for patient risk factors.
Results:
Patients undergoing combined catheterization and PCI were more likely to have undergone a previous PCI and less likely to have had chronic obstructive pulmonary disease, renal failure, a history of congestive heart failure, carotid disease, or diabetes than patients who underwent a staged procedure. After adjustment for patient risk, there were no significant differences in mortality for the 2 timing options (OR 1.14, P =.38 for combined vs staged procedures). However, patients who underwent combined procedures who had congestive heart failure in the same admission or who had Canadian Cardiovascular Society class IV had odds ratios significantly higher than congestive heart failure patients who underwent staged procedures (OR = 1.59, P =.04 and OR = 1.64, P =.04, respectively).
Conclusions:
Combined procedures appear to have mortality as low as staged procedures on average, but are less effective for some groups of high-risk patients.