Vascular disease burden and in-hospital outcomes among patients undergoing percutaneous coronary intervention in New
Jeffrey S Berger1, John L Petersen, David L Brown
1Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Insights
Patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention face higher in-hospital mortality with increasing vascular disease burden. Each additional affected vascular bed independently increases mortality risk by 50%.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Atherosclerosis in non-coronary arteries correlates with adverse cardiovascular events in stable coronary artery disease (CAD) patients.
- Limited data exists on the impact of extracardiac vascular disease on outcomes in patients undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the association between the presence and extent of vascular disease and in-hospital mortality in patients undergoing PCI.
- To determine if vascular disease burden is an independent predictor of adverse outcomes post-PCI.
Main Methods:
- Analysis of 69,045 patients undergoing PCI from the New York State Coronary Angioplasty Reporting System (1998-1999).
- Vascular disease burden assessed by history of aortoiliac, femoral-popliteal, and carotid disease.
- Logistic regression used to model the relationship between vascular disease burden and in-hospital mortality.
Main Results:
- 8.6% of patients had extracardiac vascular disease.
- In-hospital mortality increased significantly with the number of affected vascular beds: 0.7% (CAD alone), 2.0% (CAD + 1 site), and 2.6% (CAD + ≥2 sites).
- Multivariable analysis showed each additional vascular bed affected independently increased in-hospital mortality by 50% (OR, 1.50; 95% CI, 1.27-1.78).
Conclusions:
- Vascular disease burden is significantly associated with increased adverse events in patients undergoing PCI.
- The extent of extracardiac atherosclerosis is an independent predictor of in-hospital mortality following percutaneous coronary intervention.
Background:
The presence of atherosclerosis in extracardiac vascular beds is associated with an increased risk of adverse cardiovascular outcomes among stable patients with coronary artery disease (CAD). However, there is little data regarding the impact of the presence and extent of vascular disease on outcomes in patients with CAD undergoing percutaneous coronary intervention.
Methods And Results:
We analyzed 69,045 consecutive patients from the New York State Coronary Angioplasty Reporting System database who underwent percutaneous coronary intervention between 1998 and 1999. Vascular disease burden was assessed by history of aortoiliac, femoral-popliteal, and carotid disease. Patients were stratified into 3 groups: CAD alone, CAD and 1 additional site, and CAD and 2 or 3 additional sites. A logistic regression model was constructed to determine the relation between vascular disease burden and in-hospital mortality. Any history of vascular disease was present in 5915 (8.6%) of the population, of whom 4840 (82%) had CAD and 1 other disease location and 1075 (18%) had CAD and 2 or 3 other disease locations. There was a significant relationship between the number of disease locations and hospital mortality, ranging from 0.7% in patients with CAD alone to 2.0% and 2.6% for patients with 1 or >or =2 disease locations, respectively (P<0.001). In unadjusted analysis, in-hospital mortality was approximately 3-fold higher (odds ratio, 2.89; 95% CI, 2.31 to 3.60; P<0.001) and 4-fold higher (odds ratio, 3.78; 95% CI, 2.57 to 5.56; P<0.001) for inpatients with CAD and additional vascular disease at 1 site and > or =2 sites, respectively. After multivariable adjustment, each additional vascular bed affected was associated with a 50% increase in in-hospital mortality (odds ratio, 1.50; 95% CI, 1.27 to 1.78; P<0.001).
Conclusions:
Among patients with CAD undergoing percutaneous coronary intervention, vascular disease burden is associated with higher rates of adverse events and is an independent predictor of in-hospital mortality.
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