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One-Year Outcomes of Percutaneous Coronary Intervention in Patients with End-Stage Liver Disease
Daniel Y Lu1, Matthew D Saybolt2, Daniel H Kiss2
1New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA.
Insights
Percutaneous coronary intervention (PCI) in patients with cirrhosis and coronary artery disease (CAD) showed similar long-term outcomes but higher risks of bleeding and acute kidney injury (AKI). Medical management is safer for this high-risk group.
Area of Science:
- Cardiology
- Hepatology
- Interventional Cardiology
Background:
- Patients with cirrhosis and coronary artery disease (CAD) face high morbidity with surgical revascularization.
- Percutaneous coronary intervention (PCI) is an alternative, but its risks in cirrhotic patients are not well-quantified.
Purpose of the Study:
- To evaluate the long-term outcomes and procedural risks of PCI versus medical management in patients with cirrhosis and significant CAD.
Main Methods:
- Retrospective analysis of patients with CAD and cirrhosis undergoing PCI or medical management between 2007-2015.
- Outcomes assessed via medical records and telephonic follow-up.
Main Results:
- PCI was performed in 42 patients; medical management in 29.
- One-year composite outcomes (mortality, revascularization, MI) were similar (PCI: 50% vs. Control: 40%, P=.383).
- PCI group had higher adverse events (40% vs. 17%, P=.03), including severe bleeding (23%) and acute kidney injury (AKI) (26%), associated with Child-Pugh class.
Conclusions:
- PCI in cirrhotic patients carries an elevated risk of severe bleeding and AKI.
- Medical management resulted in fewer adverse outcomes compared to PCI in this cohort.
- Severity of liver disease impacts adverse event risk post-PCI.
Background:
Patients with cirrhosis and coronary artery disease (CAD) are at high risk for morbidity during surgical revascularization so they are often referred for complex percutaneous coronary intervention (PCI). Percutaneous coronary intervention in the cirrhotic population also has inherent risks; however, quantifiable data on long-term outcomes are lacking.
Methods:
Patients with angiographically significant CAD and cirrhosis were identified from the catheterization lab databases of the University of Pennsylvania Health System between 2007 and 2015. Outcomes were obtained from the medical record and telephonic contact with patients/families.
Results:
Percutaneous coronary intervention was successfully performed in 42 patients (51 PCIs). Twenty-nine patients with significant CAD were managed medically (36 angiograms). The primary outcome (a composite of mortality, subsequent revascularization, and myocardial infarction) was not significantly different between the 2 groups during a follow-up period at 1 year (PCI: 50%, Control: 40%, P = .383). In the PCI group, a composite adverse outcome rate that included acute kidney injury (AKI), severe bleed, and peri-procedural stroke was elevated (40%), with severe bleeding occurring after 23% of PCI events and post-procedural AKI occurring after 26% of events. The medical management group had significantly fewer total matched adverse outcomes (17% vs 40% in the PCI group, P = .03), with severe bleeding occurring after 11% of events and AKI occurring after 6% of events. Increased risk of adverse events following PCI was associated with severity of liver disease by Child-Pugh class.
Conclusions:
Percutaneous coronary intervention in patients with cirrhosis is associated with an elevated risk of adverse events, including severe bleeding and AKI.
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