In-Hospital Mortality of Index Percutaneous Coronary Intervention in Patients With and Without Prior Percutaneous
Pankil Desai1, Terence J Sacchi1, Manish A Parikh1
1New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States of America.
Insights
Prior percutaneous coronary intervention (PCI) is linked to lower in-hospital mortality. However, performing PCI on a previously treated lesion, especially in non-elective cases, increases mortality risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.
- The impact of prior PCI on outcomes, particularly mortality, requires further investigation.
- Understanding the influence of treating previously stented lesions is crucial for risk stratification.
Purpose of the Study:
- To determine if prior PCI affects peri-procedural and in-hospital mortality.
- To analyze the mortality risk associated with index PCI on previously treated lesions (TLR PCI) versus non-previously treated lesions (non-TLR PCI).
- To identify predictors of in-hospital mortality after PCI.
Main Methods:
- Retrospective analysis of an institutional PCI registry over a 4-year period.
- Patients were categorized based on prior PCI status and whether the index PCI targeted a previously treated lesion.
- Multivariable logistic regression was used to assess predictors of in-hospital mortality.
Main Results:
- Prior PCI was an independent predictor of lower in-hospital mortality (HR 0.41).
- Factors associated with lower mortality included younger age and elective PCI.
- Among patients with prior PCI, target lesion revascularization (TLR) PCI was associated with higher mortality (HR 3.03), particularly in non-elective cases.
Conclusions:
- PCI in patients with a history of prior PCI is associated with decreased in-hospital mortality.
- Performing index PCI on a previously treated lesion, especially in non-elective settings, increases mortality risk.
- Elective PCI on non-previously treated lesions in patients with prior PCI history is associated with the lowest mortality.
Abstract:
Percutaneous coronary intervention (PCI) is increasingly performed for symptom relief and survival benefit, particularly in patients presenting with acute coronary syndromes. It remains controversial whether prior PCI, and specifically when index PCI is performed on previously treated lesion(s), affects peri-procedural and in-hospital mortality. We queried an institutional PCI registry for all unique patients undergoing PCI during a 4-year period and classified them as having had or not prior PCI. If prior PCI had occurred, we further defined index PCI as a target lesion (TLR) PCI or non-TLR PCI, according to lesion(s) treated during the prior PCI. Multivariable analysis was performed to identify predictors of in-hospital mortality. Prior PCI was an independent predictor of in-hospital survival or lower mortality (HR 0.41 [0.22-0.76], P = 0.004), together with lower age (per 5 years, HR 0.73 [0.66-0.82], P < 0.001) and elective PCI (HR 0.63 [0.58-0.70], P < 0.0001). Among prior PCI patients, TLR PCI was associated with higher mortality (HR 3.03 [1.05-8.33]. P = 0.045), while elective PCI status was associated with lower mortality (HR 0.10 [0.01-0.80], P = 0.03). This excess mortality was only present in non-elective PCI cases (PINT = 0.02). We conclude that PCI mortality risk is decreased in patients with prior PCI, particularly when index PCI is performed electively on a lesion not previously treated.
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