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Predictors of Adverse Outcome in High-Risk Percutaneous Coronary Interventions Patients.

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Citation: Canadian Journal of Cardiology. 2023 Apr 29PMID: 37127066Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXED | Year: 2023 ISSN:

0828-282X

Name of journal: The Canadian journal of cardiologyAbstract: BACKGROUND: Identifying high-risk percutaneous coronary interventions (PCI) patients is challenging. We aimed to evaluate which high-risk patients are prone to adverse events.CONCLUSIONS: Specific features such as LM lesion or last patent conduit, pulmonary hypertension, atrial fibrillation, anemia, and renal failure, along with low SBP and NYHA-4, aid to risk stratify and to consider applying of further treatment measures. Copyright � 2023. Published by Elsevier Inc.METHODS: We performed a retrospective study including consecutive high-risk PCI between 2005-2018 in a large tertiary medical center. Patients with unprotected left main disease (LM), last patent coronary vessel or three-vessel coronary artery disease with left ventricular ejection fraction<35% were included. A predictive 30-day MACE score consisting of any myocardial infarction, all-cause death, or target vessel revascularization was constructed.RESULTS: Between 2005-2018, a total of 1,890 patients who underwent PCI met the predefined high-risk PCI criteria. Mortality rate was 8.8% at 30 days and 20.7% at 1-year, while 30-day MACE rate was 14.2% and 33.5% at 1-year. Predictors of short-term MACE were NYHA-4 (HR=6.65, p<0.001), systolic blood pressure (SBP)< 90mmHg (HR=4.93, p<0.001), creatinine>1.3mg/dL (HR=3.57, p<0.001), hemoglobin<11.0g/dL (HR=3.07 p<0.001), PASP>50mmHg (HR=2.06, p<0.001), atrial fibrillation (HR=1.74, p<0.001), and patients with LM disease (HR=2.04 p<0.001) or last patent vessel (HR=1.70, p=0.002). A score constructed from these parameters reached a sensitivity of 90% and specificity of 81% with AUC of 0.92 for MACE and an AUC of 0.94 with 89% sensitivity and 87% specificity for all-cause mortality.All authors: Abramowitz Y, Barrett O, Cafri C, El-Nasasra A, Garcia-Garcia H, Koifman E, Merkin M, Peles I, Rosenstein G, Shmueli H, Tsaban G, Zahger DFiscal year: FY2023 Digital Object Identifier:

https://dx.doi.org/10.1016/j.cjca.2023.04.021

Date added to catalog: 2023-06-28

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	37127066	Available		37127066

BACKGROUND: Identifying high-risk percutaneous coronary interventions (PCI) patients is challenging. We aimed to evaluate which high-risk patients are prone to adverse events.

CONCLUSIONS: Specific features such as LM lesion or last patent conduit, pulmonary hypertension, atrial fibrillation, anemia, and renal failure, along with low SBP and NYHA-4, aid to risk stratify and to consider applying of further treatment measures. Copyright � 2023. Published by Elsevier Inc.

METHODS: We performed a retrospective study including consecutive high-risk PCI between 2005-2018 in a large tertiary medical center. Patients with unprotected left main disease (LM), last patent coronary vessel or three-vessel coronary artery disease with left ventricular ejection fraction<35% were included. A predictive 30-day MACE score consisting of any myocardial infarction, all-cause death, or target vessel revascularization was constructed.

RESULTS: Between 2005-2018, a total of 1,890 patients who underwent PCI met the predefined high-risk PCI criteria. Mortality rate was 8.8% at 30 days and 20.7% at 1-year, while 30-day MACE rate was 14.2% and 33.5% at 1-year. Predictors of short-term MACE were NYHA-4 (HR=6.65, p<0.001), systolic blood pressure (SBP)< 90mmHg (HR=4.93, p<0.001), creatinine>1.3mg/dL (HR=3.57, p<0.001), hemoglobin<11.0g/dL (HR=3.07 p<0.001), PASP>50mmHg (HR=2.06, p<0.001), atrial fibrillation (HR=1.74, p<0.001), and patients with LM disease (HR=2.04 p<0.001) or last patent vessel (HR=1.70, p=0.002). A score constructed from these parameters reached a sensitivity of 90% and specificity of 81% with AUC of 0.92 for MACE and an AUC of 0.94 with 89% sensitivity and 87% specificity for all-cause mortality.

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