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Low weight as an independent risk factor for adverse events during cardiac catheterization of infants
Carl H Backes1, Clifford Cua, Jacqueline Kreutzer
1Nationwide Children's Hospital, Columbus, Ohio.
Insights
Infants undergoing cardiac catheterization face increased adverse events (AE) with lower weight. Neonates under 2 kg have a significantly higher risk of severe complications, including death.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatal Medicine
Background:
- Cardiac catheterization is crucial for infant diagnosis and intervention.
- Procedure type and hemodynamics influence adverse event (AE) risk.
- Impact of infant weight on AE incidence and severity is understudied.
Purpose of the Study:
- To investigate the association between infant weight and adverse events during cardiac catheterization.
- To determine if low weight is an independent risk factor for AE severity.
Main Methods:
- Prospective data collection from a multicenter registry (C3PO) of infants <1 year.
- Categorization of infants into weight groups: <2 kg, 2-3 kg, 3-5 kg, and ≥5 kg.
- Classification of AE severity (level 1-5) and multivariable analysis.
Main Results:
- AE occurred in 20% of cases, with higher rates in lower weight groups (28% for <2 kg).
- Infants <2 kg had a 12% mortality rate, predominantly in interventional cases.
- Low weight (<2 kg, 2-3 kg, 3-5 kg) was an independent risk factor for high-severity AE.
Conclusions:
- Infant weight is a significant determinant of adverse events following cardiac catheterization.
- Neonates weighing less than 2 kg face substantially elevated risks of severe complications and mortality.
- Risk stratification should consider infant weight alongside hemodynamic and procedural factors.
Background:
Studies have documented the importance of procedure type and hemodynamic variables on the incidence of procedure related adverse events (AE) after cardiac catheterization. However, little is known about the impact of low weight on the incidence and severity of AE.
Methods:
Data were prospectively collected using a multicenter registry (C3PO). Infants <1 year were divided into four weight categories: <2 kg, 2-3 kg, 3-5 kg, ≥5 kg. AE severity was classified as level 1-5 (none, minor, moderate, major, death).
Results:
Eight centers submitted details on 3,679 cases (34% diagnostic) performed in infants <1 year from 2/07 to 6/10: <2 kg: 57 (1.5%), 2-3 kg: 403 (11%), 3-5 kg: 1,527 (41.5%), ≥5 kg: 1,692 (46%). AE occurred in 20% of cases (<2 kg: 28%, 2-3 kg: 25%, 3-5 kg: 23%, ≥5 kg: 16%) with 41% of all AE being level 3-5 AE. Death occurred more frequently in the <2 kg group (12%), 71% of which were interventional cases. The case-related mortality in all other weight groups was <1%. By multivariable analysis, weight <2 kg, 2-3 kg, and 3-5 kg were independent risk factors for high severity (level 3-5) AE (<2 kg: OR 2, 95%CI 1.1-3.6; 2-3 kg: OR 1.4, 95%CI 1-1.8; 3-5 kg: OR 1.3, 95%CI 1.1-1.5), with similar findings for all AE. Blood transfusions were more common in lower weight categories (<2 kg: 42%, 2-3 kg: 29%, 3-5 kg: 25%, ≥5 kg: 15%, p<0.001).
Conclusions:
The risk of AE during cardiac catheterization of infants increases with lower weight. Infants who weigh less than 2 kg have a significantly higher risk of adverse events (most notably death) even after correcting for hemodynamic vulnerability and procedure type risk group.
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