Percutaneous coronary intervention and in-hospital outcomes in patients with leukemia: a nationwide analysis

Abstract

Objectives: To examine the association between current leukemia diagnosis and in-hospital clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) in the US.

Background: Leukemia is most common hematological malignancy and is associated with an increased risk of thrombotic and bleeding complications in patients undergoing PCI. There are limited data around clinical outcomes of leukemia patients undergoing PCI.

Methods: We used the National Inpatient Sample (NIS) to investigate the outcomes of leukemia patients undergoing PCI between 2004 and 2014. Patients were then subdivided into diagnoses of acute or chronic myeloid leukemia (AML or CML) and acute or chronic lymphoid leukemia (ALL, CLL). Multiple logistic regressions were used to study the association of a leukemia diagnosis with in-hospital outcomes; mortality, bleeding, vascular and cardiac complications, and stroke.

Results: There were 6,561,445 records of patients who underwent PCI during the study time, of which 15,789 patients had a diagnosis of leukemia. The most common leukemia subtype was CLL accounting for 75% of the cohort (n=10,800). After multivariable adjustment, a leukemia diagnosis was associated with significantly increased odds of in-hospital mortality (OR 1.41 (95% CI (1.11-1.79)) and bleeding (OR 1.87 (95% CI 1.56-2.09)), whereas patients with AML had a 5-fold increase of in-hospital mortality (OR 5.38 (95% CI 2.94-9.76)).

Conclusion: Patients with current diagnosis of leukemia are at increased risk of procedurerelated complications following PCI. A multi-disciplinary approach is needed amongst interventional cardiologists, oncologists and hematologists to minimize procedural complications and improve outcomes in this high-risk cohort.