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Percutaneous Coronary Intervention Outcomes Based on Decision-Making Capacity.

Jarmanjeet Singh1, Nicholas Kassis2, Keerat R Ahuja1

  • 1Department of Hospital Medicine Cleveland Clinic Cleveland OH.

Journal of the American Heart Association
|August 30, 2021
PubMed
Summary

Patients needing surrogate consent for percutaneous coronary intervention (PCI) faced higher mortality and adverse cardiac events. This highlights a need for increased post-procedure care for these high-risk individuals.

Keywords:
coronary angioplasty outcomesinformed consentmajor adverse cardiac eventspercutaneous coronary interventionsurrogate consent

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Area of Science:

  • Cardiology
  • Health Outcomes Research
  • Informed Consent in Medicine

Background:

  • Long-term outcomes following percutaneous coronary intervention (PCI) stratified by patient decision-making capacity remain under-investigated.
  • Assessing the impact of consent type on patient outcomes is crucial for understanding care disparities.

Purpose of the Study:

  • To compare long-term outcomes after PCI in patients who provided individual consent versus those requiring surrogate consent.
  • To identify potential differences in mortality and major adverse cardiac events between the two consent groups.

Main Methods:

  • Retrospective analysis of hospitalized patients undergoing PCI at Cleveland Clinic (2015-2016).
  • Propensity score matching was used to create comparable groups of individual and surrogate consent patients (n=149 each).
  • Kaplan-Meier analysis and log-rank tests assessed differences in 2-year all-cause mortality and major adverse cardiac events.

Main Results:

  • Patients requiring surrogate consent exhibited significantly higher 2-year all-cause mortality (25.5% vs. 10.7%, P<0.001).
  • The rate of major adverse cardiac events within 2 years was also significantly higher in the surrogate consent group (P=0.003).

Conclusions:

  • Inability to provide individual consent for PCI is associated with substantially worse long-term clinical outcomes.
  • Patients requiring surrogate consent represent a high-risk population necessitating enhanced postprocedural and postdischarge care strategies.