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In-hospital outcomes after percutaneous coronary interventions in cardiac allograft recipients
Sakiru Oyetunji Isa1, Olajide Buhari2, Muminat Adeniran-Isa1
1McLaren Flint/Michigan State University, Flint, MI, USA.
Insights
Heart transplant recipients undergoing percutaneous coronary intervention (PCI) have higher in-hospital mortality, especially those under 65. These patients also experienced longer hospital stays compared to non-transplant individuals.
Area of Science:
- Cardiology
- Transplant Surgery
- Health Outcomes Research
Background:
- Heart transplant recipient survival has improved, leading to a greater focus on long-term complications like coronary allograft vasculopathy.
- Coronary allograft vasculopathy is a leading cause of death in long-term heart transplant survivors.
- Limited large-scale data exists on the short-term outcomes of percutaneous coronary interventions (PCI) in cardiac allograft recipients.
Purpose of the Study:
- To compare the in-hospital outcomes of heart transplant recipients and non-transplant recipients undergoing PCI.
- To identify risk factors and disparities in short-term outcomes following PCI in heart transplant recipients.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database to analyze adult patients (≥18 years) who underwent PCI between January 2005 and December 2014.
- Divided patients into two groups: heart transplant recipients and non-transplant recipients.
- Compared in-hospital mortality, stroke, cardiac arrest, hospitalization duration, and total hospital charges using logistic regression models.
Main Results:
- Out of 1,316,528 PCI patients, 618 (0.05%) were heart transplant recipients.
- Heart transplant recipients were younger, with lower rates of obesity and peripheral vascular disease, but higher rates of chronic kidney disease, iron deficiency anemia, and chronic liver disease.
- In-hospital mortality was significantly higher in heart transplant recipients under 65 (adjusted OR = 2.3, p < 0.0001), who also had longer hospital stays (p = 0.002).
Conclusions:
- Heart transplant recipients under 65 years old undergoing PCI face a higher risk of in-hospital mortality.
- Heart transplant recipients, as a group, experienced longer hospitalizations compared to non-transplant patients.
- These findings highlight the need for careful consideration of percutaneous coronary interventions in heart transplant populations, particularly younger individuals.
Introduction:
The average age and survival of heart transplant recipients have improved significantly over the last 10 years. In these long-term survivors, coronary allograft vasculopathy is one of the most common causes of death. There is a paucity of large-data research highlighting the short-term outcomes of percutaneous coronary interventions in cardiac allograft recipients.
Methods:
We compared the in-hospital outcomes of heart transplant recipient and non-transplant recipients following percutaneous coronary intervention using data from the National inpatient sample (NIS). All adult patients (age ⩾ 18 years) who had percutaneous coronary intervention in the index admissions from January of 2005 to December of 2014 were included in the analysis. They were then divided into two groups based on their heart transplant status. The primary outcome was in-hospital mortality. Secondary outcomes were stroke, cardiac arrest, duration of hospitalization, and total hospital charges. Logistic regression models were used to compare in-hospital outcomes between the two groups.
Results:
Of 1,316,528 patients who had percutaneous coronary intervention, 618 (0.05%) were heart transplant recipients and 1,315,910 (99.95%) were not. The heart transplant recipient group was significantly younger with lower rates of obesity and peripheral vascular disease but higher rate of chronic kidney disease, iron deficiency anemia, and chronic liver disease. There was significantly higher in-hospital mortality in transplant recipients below 65 years of age (adjusted odds ration = 2.3, p value < 0.0001). Subjects in the heart transplant recipient group also had longer hospital stays (p value = 0.002).
Conclusion:
Heart transplant recipients younger than 65 years had higher in-hospital mortality. Subjects in the heart transplant recipient group were also younger and had longer duration of hospitalization than the non-transplant cohorts.
