Impact Of Cirrhosis On 90-Day Outcomes After Percutaneous Coronary Intervention (from A Nationwide Database)

Lu, Daniel Y.; Steitieh, Diala; Feldman, Dmitriy N.; Cheung, Jim W.; Wong, S. Chiu; Halazun, Hadi J.; Halazun, Karim J.; Amin, Nivee; Wang, Joseph; Chae, John K.; Wilensky, Robert L.; Kim, Luke K.

doi:10.1016/j.amjcard.2020.01.052

Cited by 19 publications

(21 citation statements)

References 26 publications

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“…Prior smaller studies have shown worse outcomes including mortality in patients with cirrhosis and AMI, 15,16 and this large analysis shows similar findings in the larger group of patients with CLD. The higher risk of adverse events in patients with CLD could be related to many of the above‐mentioned co‐morbidities such as renal dysfunction and haematological derangements including thrombocytopenia, anaemia and coagulopathy.…”

Section: Discussionsupporting

confidence: 79%

“…Antiplatelet agents and statins, which form the mainstay of CAD and AMI therapy, are underutilized in patients with CLD 23 . The utilization of invasive strategies has been associated with improved outcomes in this patient population, 16 which could possibly also affect outcomes. Finally, there may be an element of selection bias, whereby patients who are sicker are less likely to receive PCI and their worse outcomes may not be related to the lack of receipt of PCI, but rather to the disease process itself.…”

Section: Discussionmentioning

confidence: 99%

“…This can lead to a 'risk-aversion' tendency among treating physicians leading to lower utilization of invasive procedures in patients with CLD. Previous studies that focused on patients with AMI and cirrhosis 15,16 found that the utilization of invasive management is less in patients with cirrhosis. In this study, that included a larger group of patients with CLD, we show for the first time that the utilization of invasive management, including CA, PCI, CABG and thrombolytic therapy, was lower in patients with CLD compared to those without CLD.…”

Section: Discussionmentioning

confidence: 99%

“…While their risk of cardiovascular mortality is at least as high as patients without CLD, they are at an inherent risk of major bleeding complications due to risk factors such as anaemia, thrombocytopenia, decreased clotting factor synthesis, increased fibrinolysis and renal impairment 9‐12 . They may be less likely to receive guideline‐recommended management in the form of percutaneous coronary intervention (PCI) and dual‐antiplatelet therapy (DAPT) due to these increased risks 13‐16 . There are limited data on management strategies and clinical outcomes for this high‐risk group when presenting with AMI from a national perspective.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] They may be less likely to receive guideline-recommended management in the form of percutaneous coronary intervention (PCI) and dual-antiplatelet therapy (DAPT) due to these increased risks. [13][14][15][16] There are limited data on management strategies and clinical outcomes for this high-risk group when presenting with AMI from a national perspective. While there have been small studies on the utilization of invasive therapies and outcomes in a subset of such patients (eg ST-elevation myocardial infarction (STEMI) or AMI patients with cirrhosis), 1,2 these outcomes have not been systematically evaluated across CLD sub-groups.…”

Section: Introductionmentioning

confidence: 99%

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Trends, management and outcomes of acute myocardial infarction in chronic liver disease

et al. 2020

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Aims There are limited data on the management and outcomes of chronic liver disease (CLD) patients presenting with acute myocardial infarction (AMI), particularly according to the subtype of CLD. Methods Using the Nationwide Inpatient Sample (2004‐2015), we examined outcomes of AMI patients stratified by severity and sub‐types of CLD. Multivariable logistic regression was performed to assess the adjusted odds ratios (aOR) of receipt of invasive management and adverse outcomes in CLD groups compared with no‐CLD. Results Of 7 024 723 AMI admissions, 54 283 (0.8%) had a CLD diagnosis. CLD patients were less likely to undergo coronary angiography (CA) and percutaneous coronary intervention (PCI) (aOR 0.62, 95%CI 0.60‐0.63 and 0.59, 95%CI 0.58‐0.60, respectively), and had increased odds of adverse outcomes including major adverse cardiovascular and cerebrovascular events (1.19, 95%CI 1.15‐1.23), mortality (1.30, 95%CI 1.25‐1.34) and major bleeding (1.74, 95%CI 1.67‐1.81). In comparison to the non‐severe CLD sub‐groups, patients with all forms of severe CLD had the lower utilization of CA and PCI (P < .05). Among severe CLD patients, those with alcohol‐related liver disease (ALD) had the lowest utilization of CA and PCI; patients with ALD and other CLD (OCLD) had more adverse outcomes than the viral hepatitis sub‐group (P < .05). Conclusions CLD patients presenting with AMI are less likely to receive invasive management and are associated with worse clinical outcomes. Further differences are observed depending on the type as well as severity of CLD, with the worst management and clinical outcomes observed in those with severe ALD and OCLD.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%