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Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention.

Bashar, Hussein; Matetić, Andrija; Curzen, Nick; Mamas, Mamas A.

Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention. Thumbnail


Authors

Hussein Bashar

Andrija Matetić

Nick Curzen



Abstract

OBJECTIVES: Extracardiac vascular disease (ECVD) is increasingly recognized as a cardiovascular risk factor, but its association with outcomes after percutaneous coronary intervention (PCI) has not been well characterized. METHODS: Using the National Inpatient Sample database, all patients undergoing PCI between October 2015 and December 2018 were stratified by the presence and organ-specific extent of extracardiac vascular comorbidity (cerebrovascular disease (CeVD), renovascular, aortic and peripheral arterial disease (PAD)). Primary outcome was all-cause mortality and secondary outcomes were (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) acute ischemic stroke and (c) major bleeding. Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) and 95% confidence interval (95% CI). RESULTS: Of a total of 1,403,505 patients undergoing PCI during the study period, 199,470 (14.2%) had ECVD. Patients with ECVD were older (median of 72 years vs. 70 years, p?<?0.001) and had higher comorbidity burden that their counterparts. All cause-mortality was 22% higher in patients with any ECVD compared to those without ECVD. PAD patients had the highest odds of all-cause mortality (aOR 1.48, 95% CI 1.40-1.56), followed by those with CeVD (aOR 1.15, 95% CI 1.10-1.19). Patients with extracardiac disease had increased odds of MACCE, ischemic stroke and bleeding, irrespective of the nature or extent (p?<?0.05), compared to patients without ECVD. CONCLUSION: ECVD is associated with worse outcomes in patients undergoing PCI including significantly higher rates of death and stroke. These data should inform our shared decision-making process with our patients.

Journal Article Type Article
Acceptance Date Sep 7, 2022
Online Publication Date Sep 21, 2022
Publication Date Sep 21, 2022
Publicly Available Date Mar 28, 2024
Journal Catheterization and Cardiovascular Interventions
Print ISSN 1522-1946
Publisher Wiley
Volume 100
Issue 5
Pages 737-746
DOI https://doi.org/10.1002/ccd.30404
Keywords Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and imaging, General Medicine
Publisher URL https://onlinelibrary.wiley.com/doi/10.1002/ccd.30404

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