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Percutaneous coronary intervention in patients with cardiac allograft vasculopathy: a Nationwide Inpatient Sample
Waqas Ullah1, Nishant Thalambedu1, Salman Zahid2
1Internal Medicine, Abington Jefferson Health, Abington, PA, USA.
Insights
Percutaneous coronary intervention (PCI) for cardiac allograft vasculopathy (CAV) did not show significant differences in major complications or mortality. However, PCI may increase in-hospital complications and resource use in heart transplant patients with CAV.
Area of Science:
- Cardiology
- Transplantation Medicine
- Interventional Cardiology
Background:
- Cardiac allograft vasculopathy (CAV) is a primary driver of heart transplant failure and patient mortality.
- The efficacy and safety of percutaneous coronary intervention (PCI) in CAV patients are not well-established.
Purpose of the Study:
- To evaluate the role and outcomes of PCI in patients diagnosed with cardiac allograft vasculopathy.
- To compare in-hospital complications and mortality rates between CAV patients who underwent PCI and those treated conservatively.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2015-2017 to identify patients with CAV.
- Employed propensity-matched multivariate logistic regression to assess the impact of PCI.
- Calculated adjusted odds ratios (aOR) for various in-hospital complications.
Main Results:
- Analysis included 2,380 CAV patients (185 PCI, 2,195 no-PCI).
- No significant differences were observed in major bleeding, post-procedure bleeding, cardiogenic shock, acute kidney injury, cardiopulmonary arrest, or in-hospital mortality between PCI and no-PCI groups.
- Propensity-matched analysis corroborated the unadjusted findings.
Conclusions:
- PCI in patients with cardiac allograft vasculopathy may be linked to an increase in in-hospital complications.
- PCI use in CAV patients might also be associated with higher healthcare resource utilization.
Abstract:
Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure and mortality. The role of percutaneous coronary intervention (PCI) in these patients remains unknown.Methods: The National Inpatient Sample (NIS) (2015-2017) was queried to identify all cases of CAV. The merits of PCI were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for in-hospital complications were calculated.Results: A total of 2,380 patients (PCI 185, no-PCI 21,95) with CAV were included in the analysis. There was no significant difference in the odds of major bleeding (OR 1.87, 95% CI 0.94-3.7, P = 0.11), post-procedure bleeding (P = 0.37), cardiogenic shock (OR 0.87, 95% CI 0.45-1.69, P = 0.80), acute kidney injury (uOR 0.92, 95% CI 0.68-1.24, P = 0.64), cardiopulmonary arrest (OR 0.84, 95% CI 0.34-2.11, P = 0.88), and in-hospital mortality (OR 1.59, 95% CI 0.91-2.79, P = 0.14) between patients undergoing PCI compared to those treated conservatively. A propensity-matched analysis closely followed the results of unadjusted crude analysis.Conclusion: PCI in CAV may be associated with increased in-hospital complications and higher resource utilization.
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