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Coarctation Angioplasty in Young Children: Does IMPACT Registry Data Accurately Reflect Clinical Outcomes?
Aditya P Desai1, Mark H Hoyer2,3
1Indiana University School of Medicine, Indianapolis, 340 W 10Th St, Indianapolis, IN, USA.
Insights
Balloon angioplasty for coarctation of the aorta (CA) is successful if the gradient is <10 mmHg. However, this acute success metric does not predict long-term clinical outcomes in pediatric patients. Older patients showed better results.
Area of Science:
- Cardiology
- Pediatric Interventional Cardiology
- Medical Devices
Background:
- Balloon angioplasty is a common treatment for coarctation of the aorta (CA) in children.
- Acute procedural success is typically defined by a post-procedure systolic gradient of less than 10 mmHg.
- The IMPACT registry uses this gradient threshold to assess institutional performance.
Purpose of the Study:
- To evaluate if the IMPACT registry's definition of acute procedural success (<10 mmHg gradient) correlates with actual clinical patient outcomes after balloon angioplasty for CA.
- To identify predictors of successful clinical outcomes in pediatric patients undergoing CA balloon angioplasty.
Main Methods:
- Analysis of IMPACT registry data from February 2012 to December 2020, including 110 coarctation interventions.
- Review of electronic medical records to determine primary endpoints: death or reintervention.
- Comparison of clinical outcomes based on acute success criteria (gradient <10 mmHg) and patient age.
Main Results:
- 58.2% of interventions achieved the acute success endpoint (gradient <10 mmHg).
- No significant relationship was found between IMPACT acute success criteria and clinical patient outcomes (p=0.70).
- Older patient age was significantly associated with better clinical outcomes (p=0.0093).
Conclusions:
- The IMPACT definition of acute procedural success for CA balloon angioplasty does not reliably predict long-term clinical outcomes.
- Current acute success metrics may need reevaluation.
- Further research is needed to identify clinical factors that better predict outcomes in pediatric CA patients.
Abstract:
Balloon angioplasty for recoarctation of the aorta is routinely performed in young children and is considered successful when the systolic gradient is reduced to < 10 mmHg. IMPACT defines acute procedural success solely based on a final gradient of < 10 mmHg and stratifies participating institutions based on these acute outcomes. Between February 2012 and December 2020, IMPACT data was analyzed for 110 coarctation interventions. Electronic medical records were reviewed, and primary endpoints were one of the following: (1) final analysis end date (June 2021), (2) patient death, or (3) most recent transcatheter or surgical reintervention. 64 (58.2%) interventions had a post-procedure CA gradient < 10 mmHg. Comparison of clinical patient outcome for acute success demonstrated no significant relationship using IMPACT (p = 0.70) criteria. There was no statistically significant difference between clinical success and failure for: pre- and post-treatment systolic gradients; absolute or percent change in systolic gradient; and pre-treatment aorta diameter. Clinical outcome and patient age did show a significant difference (p = 0.0093) with better clinical outcomes in older patients. Our analysis did not reveal a statistically significant difference between IMPACT criteria for successful treatment of CA and clinical outcome. These findings underscore a need to identify other clinical metrics that better predict outcome following CA balloon angioplasty treatment.
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