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Published on: January 28, 2020
Prognosis of Patients with Crohn's Disease and Ulcerative Colitis Following Percutaneous Coronary Intervention
Jill Savren Lotker1, Ariel Roguin2, Arthur Kerner3
1Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Patients with inflammatory bowel disease (IBD) face higher risks following percutaneous coronary intervention (PCI). Crohn's disease (CD) patients experienced more target lesion failure (TLF) than ulcerative colitis (UC) patients within five years post-PCI.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Outcomes Research
Background:
- Patients with inflammatory bowel disease (IBD) exhibit increased risks after percutaneous coronary intervention (PCI).
- Understanding these risks is crucial for managing cardiovascular health in IBD patients.
Purpose of the Study:
- To compare clinical outcomes within 30 days, one year, and five years following PCI in IBD patients.
- To identify differences in outcomes between Crohn's disease (CD) and ulcerative colitis (UC) patients undergoing PCI.
Main Methods:
- Retrospective cohort study of 44 adult IBD patients undergoing PCI between January 2009 and December 2019.
- Comparison of clinical outcomes, including acute coronary syndromes (ACS) and target lesion failure (TLF).
Main Results:
- Crohn's disease patients were younger, more likely male, and had higher non-steroidal treatment rates compared to ulcerative colitis patients.
- Acute coronary syndromes and/or revascularization were common post-PCI events in both groups.
- Target lesion failure (TLF) rates within five years were higher in IBD patients (40% CD vs. 25% UC), with in-stent restenosis and stent thrombosis noted as causes.
Conclusions:
- Inflammatory bowel disease patients demonstrate elevated target lesion failure rates post-PCI compared to the general population.
- Significant differences in clinical outcomes exist between Crohn's disease and ulcerative colitis patients.
- Further research into prognostic factors and pathophysiology is needed to tailor treatments for this high-risk group.
Background:
Patients with inflammatory bowel disease (IBD) are at increased risk after percutaneous coronary intervention (PCI).
Objectives:
To compare the clinical outcomes within 30 days, one year, and five years of undergoing PCI.
Methods:
We conducted a retrospective cohort study of adult patients with IBD who underwent PCI in a tertiary care center from January 2009 to December 2019.
Results:
We included 44 patients, 26 with Crohn's disease (CD) and 18 with ulcerative colitis (UC), who underwent PCI. Patients with CD underwent PCI at a younger age compared to UC (57.8 vs. 68.9 years, P < 0.001) and were more likely to be male (88.46% of CD vs. 61.1% of UC, P < 0.03). CD patients had a higher rate of non-steroidal treatment compared to UC patients (50% vs. 5.56%, P < 0.001). Acute coronary syndromes (ACS) and/or the need for revascularization (e.g., PCI) were the most common clinical events to occur following PCI, in both groups. Of patients who experienced ACS and/or unplanned revascularization within 5 years, 25% of UC vs. 40% of CD had target lesion failure (TLF) due to in-stent restenosis and 10% of CD had TLF due to stent thrombosis.
Conclusions:
We observed higher rates of TLF in IBD patients compared to the general population as well as differences in clinical outcomes between UC and CD patients. A better understanding of the prognostic factors and pathophysiology of these differences may have clinical importance in tailoring the appropriate treatment or type of revascularization for this high-risk group.
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