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Temporal Changes in Co-Morbidity Burden in Patients Having Percutaneous Coronary Intervention and Impact on Prognosis
Jessica Potts1, Chun Shing Kwok1, Joie Ensor1
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, United Kingdom.
Insights
Increased comorbidity burden significantly raises risks for patients undergoing percutaneous coronary intervention (PCI). Higher Charlson Comorbidity Scores (CCI) correlate with greater in-hospital mortality, complications, longer stays, and higher costs post-PCI.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- The impact of patient comorbidity burden on PCI outcomes is not fully elucidated.
- Rising comorbidity prevalence necessitates understanding its influence on healthcare utilization and patient safety.
Purpose of the Study:
- To evaluate the association between comorbidity burden and in-hospital outcomes following PCI.
- To analyze trends in comorbidity burden among PCI patients over a decade.
- To quantify the risk of mortality, complications, and resource utilization associated with increasing comorbidity.
Main Methods:
- Utilized the Nationwide Inpatient Sample (NIS) database for PCI procedures from 2004-2014.
- Assessed comorbidity burden using the Charlson Comorbidity Score (CCI).
- Employed multivariable logistic regression to analyze the relationship between CCI and in-hospital outcomes, adjusting for confounders.
Main Results:
- A total of 6,601,526 PCI procedures were analyzed.
- Comorbidity burden, particularly severe burden (CCI ≥3), significantly increased from 2004 to 2014.
- Higher CCI scores were independently associated with increased in-hospital mortality (OR 1.19-1.96), complications, length of stay, and hospitalization costs.
Conclusions:
- Comorbidity burden is a significant independent predictor of adverse outcomes after PCI.
- Healthcare providers must consider comorbidity when managing patients undergoing PCI.
- Strategies to mitigate risks associated with high comorbidity burden in PCI patients are warranted.
Abstract:
This study aims to evaluate the impact of co-morbidity burden on outcomes in patients who undergo percutaneous coronary intervention (PCI). We used the Nationwide Inpatient Sample to identify all PCI procedures undertaken in the United States from 2004 to 2014. We then determined co-morbidity burden for each patient record based on the Charlson Co-morbidity Score. Multivariable logistic regression models were used to examine the association between co-morbidity burden and in-hospital mortality other in-hospital complications. A total of 6,601,526 PCI procedures were included in the analysis. Overall co-morbidity burden increased over time, with severe co-morbidity burden (defined as a CCI score ≥3) increasing from 5.3% in 2004 to 14.2% in 2014 (p <0.0001). After adjustment for confounding factors increasing co-morbidity burden was independently associated with increased odds of in-hospital mortality, complications, length of hospital stay, and total cost of hospitalization post PCI. A CCI score of 1 was independently associated with an increase in the odds of in hospital mortality (odds ratio [OR] 1.19 [95% confidence interval [CI] 1.15 to 1.25]), a score of 2 associated with an almost 1.5-fold increase (OR 1.41 [95% CI 1.34 to 1.48]) and a score of ≥3 a 2-fold increase (OR 1.96 [95% CI 1.86 to 2.07]) compared with no co-morbid burden (CCI score of 0). In conclusion, our results show that co-morbid burden is independently associated with increased risk of in-hospital mortality, in-hospital complications, length of stay, and healthcare costs.
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