Percutaneous coronary intervention in patients with cardiac allograft vasculopathy: a Nationwide Inpatient Sample (NIS) database analysis

ABSTRACT

Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure and mortality. The role of percutaneous coronary intervention (PCI) in these patients remains unknown.

Methods: The National Inpatient Sample (NIS) (2015–2017) was queried to identify all cases of CAV. The merits of PCI were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for in-hospital complications were calculated.

Results: A total of 2,380 patients (PCI 185, no-PCI 21,95) with CAV were included in the analysis. There was no significant difference in the odds of major bleeding (OR 1.87, 95% CI 0.94–3.7, P = 0.11), post-procedure bleeding (P = 0.37), cardiogenic shock (OR 0.87, 95% CI 0.45–1.69, P = 0.80), acute kidney injury (uOR 0.92, 95% CI 0.68–1.24, P = 0.64), cardiopulmonary arrest (OR 0.84, 95% CI 0.34–2.11, P = 0.88), and in-hospital mortality (OR 1.59, 95% CI 0.91–2.79, P = 0.14) between patients undergoing PCI compared to those treated conservatively. A propensity-matched analysis closely followed the results of unadjusted crude analysis.

Conclusion: PCI in CAV may be associated with increased in-hospital complications and higher resource utilization.

KEYWORDS:

• Transplant
• percutaneous coronary intervention
• cardiac allograft vasculopathy
• CAV
• PCI

Article highlights

• We present one of the largest contemporary study of 2380 patients from a real-life population sample to evaluated in-hospital outcomes and resource utilization for patients with cardiac allograft vasculopathy undergoing percutaneous coronary intervention.

• Mortality in patients with cardiac allograft vasculopathy undergoing PCI is 8 times higher compared to patients managed conservatively.

• PCI in patients with allograft vasculopathy is associated with increased length of stay and resource utilizations.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was supported by. Department of Veterans Affairs, World Heart Federation, Tahir and Jooma Family Honorarium: American College of Cardiology (Associate Editor for Innovations, acc.org).