Jessica Potts1, Vinayak Nagaraja1,2, Jassim Al Suwaidi3, Salvatore Brugaletta4, Sara C Martinez5, Chadi Alraies6, David Fischman7, Chun Shing Kwok1, Jim Nolan1, Darren Mylotte8, Mamas A Mamas1,9. 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom. 2. Department of Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia. 3. Weill Cornell Medical School, Qatar, Department of Cardiology, Hamad General Hospital, Doha, Qatar. 4. Division of Cardiology, Cardiovascular Institute, Hospital Clinic, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. 5. Division of Cardiology, Providence St. Peter Hospital, Washington. 6. Division of Cardiology, Wayne State University, Detroit Medical Center Heart Hospital, Detroit, Michigan. 7. Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 8. Department of Cardiology, University Hospital Galway, Galway, Ireland. 9. Institute of Population Health Sciences, University of Manchester, Manchester, England, United Kingdom.
Abstract
BACKGROUND: Clinical outcomes with respect to the evolution of comorbidity burden in national cohorts of patients undergoing PCI have not been reported. OBJECTIVES: We sought to explore the association between comorbidity burden and periprocedural outcomes in patients treated with PCI in the National Inpatient Sample. METHODS: 6,601,526 PCI procedures were identified between 2004 and 2014 and comorbidities were defined by the Elixhauser classification system (ECS) consisting of 30 comorbidity measures. Endpoints included in-hospital mortality, periprocedural complications, length of stay and cost. Patients were classified based on their ECS in five categories (ECS I < 0, ECS II = 0, ECS III = 1-5, ECS IV = 6-13, and ECS V ≥ 14). RESULTS: Patients with a score over 13 had a fivefold increase in the odds of mortality (OR: 5.13, 95% CI: 4.76-5.54), major bleeding (OR: 11.46, 95% CI: 10.66-12.33) and doubled the hospitalization costs ($31,452 vs $17.566). CONCLUSIONS: Our study of over six million PCI procedures demonstrates that patients with the greatest comorbid burden (as defined by an ECS of >13) have a fivefold increase risk of in-hospital mortality, a fourfold increase in in-hospital periprocedural complications and an 11-fold increase in major bleeding events once differences in baseline patient characteristics are adjusted for. In addition, ECS significantly impacts the length of stay and doubles the healthcare costs. Comorbid burden is an important predictor of poor outcomes after PCI and should be considered as part of the decision-making processes in patients undergoing PCI.
BACKGROUND: Clinical outcomes with respect to the evolution of comorbidity burden in national cohorts of patients undergoing PCI have not been reported. OBJECTIVES: We sought to explore the association between comorbidity burden and periprocedural outcomes in patients treated with PCI in the National Inpatient Sample. METHODS: 6,601,526 PCI procedures were identified between 2004 and 2014 and comorbidities were defined by the Elixhauser classification system (ECS) consisting of 30 comorbidity measures. Endpoints included in-hospital mortality, periprocedural complications, length of stay and cost. Patients were classified based on their ECS in five categories (ECS I < 0, ECS II = 0, ECS III = 1-5, ECS IV = 6-13, and ECS V ≥ 14). RESULTS:Patients with a score over 13 had a fivefold increase in the odds of mortality (OR: 5.13, 95% CI: 4.76-5.54), major bleeding (OR: 11.46, 95% CI: 10.66-12.33) and doubled the hospitalization costs ($31,452 vs $17.566). CONCLUSIONS: Our study of over six million PCI procedures demonstrates that patients with the greatest comorbid burden (as defined by an ECS of >13) have a fivefold increase risk of in-hospital mortality, a fourfold increase in in-hospital periprocedural complications and an 11-fold increase in major bleeding events once differences in baseline patient characteristics are adjusted for. In addition, ECS significantly impacts the length of stay and doubles the healthcare costs. Comorbid burden is an important predictor of poor outcomes after PCI and should be considered as part of the decision-making processes in patients undergoing PCI.
Authors: Mohamed O Mohamed; Nick Curzen; Mark de Belder; Andrew T Goodwin; James C Spratt; Lognathen Balacumaraswami; John Deanfield; Glen P Martin; Muhammad Rashid; Ahmad Shoaib; Chris P Gale; Tim Kinnaird; Mamas A Mamas Journal: Catheter Cardiovasc Interv Date: 2021-03-25 Impact factor: 2.585
Authors: N Salet; V A Stangenberger; F Eijkenaar; F T Schut; M C Schut; R H Bremmer; A Abu-Hanna Journal: Sci Rep Date: 2022-04-07 Impact factor: 4.379