Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention

Abstract

Objectives Extracardiac vascular disease (ECVD) is increasingly recognized as a cardiovascular risk factor, but its association with outcomes after percutaneous coronary intervention (PCI) has not been well characterized. Methods Using the National Inpatient Sample database, all patients undergoing PCI between October 2015 and December 2018 were stratified by the presence and organ‐specific extent of extracardiac vascular comorbidity (cerebrovascular disease (CeVD), renovascular, aortic and peripheral arterial disease (PAD)). Primary outcome was all‐cause mortality and secondary outcomes were (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) acute ischemic stroke and (c) major bleeding. Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) and 95% confidence interval (95% CI). Results Of a total of 1,403,505 patients undergoing PCI during the study period, 199,470 (14.2%) had ECVD. Patients with ECVD were older (median of 72 years vs. 70 years, p < 0.001) and had higher comorbidity burden that their counterparts. All cause‐mortality was 22% higher in patients with any ECVD compared to those without ECVD. PAD patients had the highest odds of all‐cause mortality (aOR 1.48, 95% CI 1.40–1.56), followed by those with CeVD (aOR 1.15, 95% CI 1.10–1.19). Patients with extracardiac disease had increased odds of MACCE, ischemic stroke and bleeding, irrespective of the nature or extent (p < 0.05), compared to patients without ECVD. Conclusion ECVD is associated with worse outcomes in patients undergoing PCI including significantly higher rates of death and stroke. These data should inform our shared decision‐making process with our patients.

Prognostic impact of peripheral artery disease in patients with and without high bleeding risk undergoing percutaneous coronary intervention

“…16 On the other hand, the increased risk of bleeding events of PAD patients is probably determined by the higher likelihood of periprocedural bleeding involving the vascular access and by the increased prevalence of some high-risk features such as advanced age or CKD, which affect not only ischemic but also bleeding risk. 1,5,6 We found that after adjustment for cardiovascular risk factors, comorbidities and CAD severity, the impact of PAD on ischemic and bleeding complications decreased and was no longer significant in both HBR and no-HBR patients. PAD remained an independent Of note, in some previous reports, PAD remained a significant predictor of adverse outcomes after adjustment 1,2 ; however, the endpoints' definitions and/or variables included in the adjusted models differed from our study.…”

“…Our results are consistent with previous studies that did not stratify patients according to the HBR status, which showed that PAD patients are at increased risk of both ischemic and bleeding complications after PCI, with the risk for ischemic events tending to be greater. 1,4,5,7,13 The accrued hazard of ischemic complications of PAD patients might be explained by the higher frequency of cardiovascular risk factors (e.g., advanced age, smoking or diabetes), 4,6,7 the elevated pro-inflammatory status 14,15 and the increased platelet reactivity. 16 On the other hand, the increased risk of bleeding events of PAD patients is probably determined by the higher likelihood of periprocedural bleeding involving the vascular access and by the increased prevalence of some high-risk features such as advanced age or CKD, which affect not only ischemic but also bleeding risk.…”

“…Peripheral artery disease (PAD) affects about 5%-10% of patients undergoing percutaneous coronary intervention (PCI). [1][2][3][4][5] Even with the development of new generation drug-eluting stents (DESs) and more potent antithrombotic therapies, PAD continues to be associated with increased risk of recurrent myocardial infarction (MI), repeat coronary revascularization, and mortality after PCI. 1,4,6 In addition, some analyses found that PAD patients are more likely to experience bleeding complications after PCI, especially in case of vascular access through the femoral artery.…”

“…1,4,6 In addition, some analyses found that PAD patients are more likely to experience bleeding complications after PCI, especially in case of vascular access through the femoral artery. 1,4,5,7 Features associated with high bleeding risk (HBR) are found in more than 40% of patients undergoing PCI. [8][9][10] In HBR patients, the hazard of bleeding events largely exceeds that of ischemic complications and has a major impact on mortality.…”

Peripheral arterial disease and multisite atherosclerosis in patients undergoing percutaneous coronary intervention

“…In this issue of the Journal, Bashar et al 2 leveraged the National Inpatient Sample database, which is derived from all the states participating in the Healthcare Cost and Utilization Project (HCUP) and covers more than 97% of the US population. In this analysis, they included about 1.4 million patients undergoing PCI and evaluated in‐hospital outcomes in relation to the type of PAD as well as the number of vascular beds involved.…”