Extracardiac vascular disease may drive worse outcomes after PCI
In adults who undergo PCI, concomitant extracardiac vascular disease is associated with worse clinical outcomes, including all-cause death, regardless of the organ involved and the number of vascular beds, researchers reported.
“Extracardiac vascular disease can contribute to increased morbidity and technical challenges for diagnosis and treatment of patients with coronary disease, especially those being considered for revascularization because of factors including vascular access, renal function, frailty and neurologic sequelae,” Mamas A. Mamas, DPhil, MRCP, professor of cardiology in the Keele Cardiovascular Research Group at Keele University in Staffordshire, U.K. and colleagues wrote in the study background. “Previous studies have investigated the association of extracardiac atherosclerosis disease and outcomes after acute MI, including in PCI cohorts. ... However, these studies do not reflect contemporary practice and do not consider whether there is a differential impact according to the vascular bed involved.”
Mamas and colleagues analyzed data from 1,403,505 patients undergoing PCI between October 2015 and December 2018 using the National Inpatient Sample database, stratified by the presence and organ-specific extent of extracardiac vascular comorbidity. The primary outcome was all-cause mortality; secondary outcomes included major adverse CV and cerebrovascular events (MACCE), acute ischemic stroke and major bleeding.
The findings were published in Catheterization and Cardiovascular Interventions.
Within the cohort, 14.2% of patients had extracardiac vascular disease.
Researchers found that all cause‐mortality was 22% higher among patients with any extracardiac vascular disease compared with those without. Patients with peripheral artery disease were most likely to experience all-cause mortality, with an adjusted OR of 1.48 (95% CI, 1.4-1.56), followed by patients with cerebrovascular disease, with an adjusted OR of 1.15 (95% CI, 1.1-1.19).
Those with extracardiac vascular disease were more likely to experience MACCE, ischemic stroke and bleeding, irrespective of the nature or extent (P < .05), compared with patients without extracardiac vascular disease.
“These data should facilitate accurate counseling for patients with extracardiac atherosclerosis about their risk before PCI and thereby assist them in making an informed decision,” the researchers wrote. “Second, these data should encourage identification of those with more extensive atherosclerosis to guide optimization of disease‐modifying medical therapies and closer monitoring of modifiable risk factors. Third, it raises the question whether the diagnosis of atherosclerosis in one territory should promote the screening for the disease in other vascular beds to guide possible prognostic interventions and to provide more accurate procedural risk stratification.”
Collapse