Association of multimorbidity burden with outcomes after percutaneous coronary intervention: a retrospective cohort...

Multimorbidity is increasingly common among patients undergoing percutaneous coronary intervention (PCI), particularly in aging populations. Although previous studies have shown that comorbidity burden influences outcomes in coronary artery disease, the association between cumulative multimorbidity burden and both clinical and functional outcomes after PCI in contemporary real-world practice remains incompletely characterized.

This single-center retrospective cohort study included 1,238 consecutive patients who underwent PCI between January 2020 and December 2023. Patients were categorized into a low-burden group (0-1 chronic disease, n = 482) and a high-burden group (≥ 2 chronic diseases, n = 756). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and repeat coronary revascularization. Multivariable Cox regression and propensity score matching were performed for time-to-event outcomes. Functional outcomes, including New York Heart Association (NYHA) class, Seattle Angina Questionnaire-7 (SAQ-7), and EuroQol Five Dimensions (EQ-5D), were assessed from baseline to 12-month follow-up.

Over a median follow-up of 36 months (IQR 28-42), 312 patients (25.2%) experienced MACE. The incidence of MACE was significantly higher in the high-burden group than in the low-burden group (30.4% vs. 17.0%, P < 0.001; log-rank P < 0.001). After multivariable adjustment, high multimorbidity burden remained associated with increased risk of MACE (adjusted HR = 1.52, 95% CI: 1.18-1.96, P = 0.001). All-cause mortality (13.6% vs. 7.3%, P < 0.001) and all-cause readmission (27.0% vs. 18.0%, P < 0.001) were also more frequent in the high-burden group. Functional recovery at 12 months was less favorable in patients with higher multimorbidity burden, with lower improvement in NYHA class (45.3% vs. 62.0%, P < 0.001), smaller increases in SAQ-7 score (+ 15.1 ± 6.8 vs. +22.6 ± 7.5, P < 0.001), and less improvement in EQ-5D index (+ 0.09 ± 0.11 vs. +0.14 ± 0.10, P < 0.001). Subgroup analyses showed generally consistent associations across age and sex strata, whereas disease-specific subgroup findings were interpreted cautiously because some stratification variables also contributed to the multimorbidity definition.

In this single-center retrospective cohort, higher multimorbidity burden was associated with increased risks of adverse clinical outcomes and less favorable functional recovery after PCI. These findings suggest that multimorbidity may provide additional prognostic information in contemporary PCI practice, although further prospective multicenter studies are needed to confirm its value in routine risk assessment.