MACCE, mortality, stroke in PCI less common in Crohn’s disease, ulcerative colitis
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Patients with Crohn’s disease or ulcerative colitis who underwent PCI had a lower rate of in-hospital MACCE, mortality and stroke or transient ischemic attack compared with those without inflammatory bowel disease, researchers reported.
However, patients with either form of inflammatory bowel disease were found to be at greater risk for major bleeding.
“This is the first national-level analysis comparing procedural outcomes between patients with and without IBD undergoing PCI,” Ofer Kobo, MD, MHA, of the department of cardiology at Hillel Yaffe Medical Center, Hadera, Israel, and colleagues wrote.
For the analysis published in the American Journal of Cardiology, researchers identified PCI-related hospitalizations using the National Inpatient Sample (2004-2015) and stratified patients as having Crohn’s disease, ulcerative colitis or neither.
Among patients who underwent PCI, 0.3% also had a diagnosis of inflammatory bowel disease. From 2004 to 2015, the prevalence of the disease increased from 0.2% to 0.4%.
In a multivariable analysis, patients with Crohn’s disease or ulcerative colitis had decreased odds for in-hospital MACCE, defined as mortality, acute stroke or TIA and cardiac complications (Crohn’s disease, OR = 0.69; 95% CI, 0.62-0.78; ulcerative colitis, OR = 0.75; 95% CI, 0.66-0.85), mortality (Crohn’s disease, OR = 0.94; 95% CI, 0.79-1.11; ulcerative colitis, OR = 0.35; 95% CI, 0.27-0.45) and acute stroke or TIA (Crohn’s disease, OR = 0.73; 95% CI, 0.6-0.89; ulcerative colitis, OR = 0.94; 95% CI, 0.77-1.15) compared with patients without inflammatory bowel disease.
Moreover, patients with Crohn’s disease or ulcerative colitis who underwent PCI experienced greater odds for major bleeding (Crohn’s disease, OR = 1.42; 95% CI, 1.23-1.63;ulcerative colitis, OR = 1.35; 95% CI, 1.16-1.58), compared with those without inflammatory bowel disease.
“Patients with inflammatory bowel diseases undergoing PCI tend to be younger, with less traditional cardiovascular risk factors than those without IBD. We show that these patients are at increased risk of major bleeding complications, but overall, their outcomes are good with lower in hospital mortality and MACCE,” Mamas A. Mamas, DPhil, professor of cardiology of the Keele Cardiovascular Research Group at Keele University, Staffordshire, U.K., told Healio. “This paper is important in that it highlights the increased risk of bleeding complications in these patients and the importance of adopting bleeding avoidance strategies during these procedures such as the radial approach and use of stent platforms that only require short periods of DAPT.
“The areas of future work are to study the longer-term outcomes of these patients post discharge, as there is no current literature in this regard,” Mamas said in an interview.
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