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Pericardial tamponade in coronary interventions: Morbidity and mortality
Saurabh Deshpande1, Hiroyuki Sawatari2,3, Kapil Rangan1
1Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
Insights
Cardiac tamponade, a complication of cardiac procedures, occurred in 3.3%-8.4% of patients. Older patients undergoing chronic total occlusion percutaneous transluminal coronary angioplasty had higher mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Cardiac tamponade (PT) is a potential complication following invasive cardiac procedures.
- Understanding the incidence and outcomes of PT is crucial for patient safety in cardiac catheterization labs.
Purpose of the Study:
- To investigate the frequency and in-hospital mortality associated with PT-related events in patients undergoing coronary interventions (CI).
- To identify risk factors for mortality in patients experiencing PT during CI.
Main Methods:
- Utilized the Nationwide Inpatient Sample (NIS) database to identify patients undergoing CI.
- Extracted data on patient demographics, comorbidities, PT-related events, and in-hospital death using ICD-9-CM and ICD-10-CM codes.
- Analyzed the frequency of PT events and in-hospital mortality rates, assessing the impact of age, sex, and procedure type.
Main Results:
- The frequency of PT-related events ranged from 3.3% to 8.4% between 2010 and 2017.
- In-hospital mortality related to PT events was 8.5% for coronary procedures.
- Mortality was significantly higher in older patients and female patients, particularly those undergoing chronic total occlusion (CTO) procedures.
- Patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS) had the highest in-hospital mortality.
Conclusions:
- PT-related events occur in 3.3%-8.4% of CI procedures, with an 8.5% in-hospital mortality rate.
- PTCA for ACS is associated with the highest mortality.
- Older age and CTO PTCA are independent predictors of increased mortality.
Background:
Cardiac tamponade or pericardial tamponade (PT) can be a complication following invasive cardiac procedures.
Methods:
Patients who underwent various procedures in the cardiac catheterization lab (viz. coronary interventions) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (International classification of diseases [ICD]-9-Clinical modification [CM] and ICD-10-CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, PT-related events, and in-hospital death were also abstracted from the NIS database.
Results:
The frequency of PT-related events in the patients undergoing CI from 2010 to 2017 ranged from 3.3% to 8.4%. Combined in-hospital mortality/morbidity of PT-related events were higher with increasing age (odds ratio [OR] [95% CI]: chronic total occlusion (CTO) = 1.19 [1.10-1.29]; acute coronary syndrome (ACS) = 1.21 [1.11-1.33], both p < 0.0001) and female sex (OR [95%CI]: CTO = 1.70 [1.45-2.00]; ACS = 1.72 [1.44-2.06], both p < 0.0001). In-hospital mortality related to PT-related events was found to be 8.5% for coronary procedures. In-hospital mortality was highest amongst the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for ACS (ACS vs. non-CTO PTCA vs. CTO PTCA: 15.7% vs. 10.4% and 14.4%, p < 0.0001 and ACS vs. non-CTO PTCA vs. CTO PTCA: 12.1% vs. 8.1% and 5.6%, p = 0.0001, respectively).
Conclusions:
In the real-world setting, PT-related events in CI were found to be 3.3%-8.4%, with in-hospital mortality of 8.5%. The patients undergoing PTCA for ACS were found to have highest mortality. Older patients undergoing CTO PTCA independently predicted higher mortality.
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