Chronic liver disease associated with worse PCI outcomes
Patients with chronic liver disease (CLD) who undergo percutaneous coronary intervention (PCI) face a greater risk of adverse outcomes, according to new data published in the American Journal of Cardiology.
The study analyzed data from 7,296,679 hospitalized adult patients who underwent PCI at least once from January 2004 to September 2015. More than 54,000 of those patients had CLD. While 68.4% were men, the median patient age was 60 years old. All data came from the Nationwide Inpatient Sample.
The researchers found that major adverse cardiovascular and cerebrovascular events (MACCE), all-cause mortality, major bleeding, and cardiac complications are more likely to occur in this cohort compared with patients who don't have CLD.
In addition, patients with severe CLD and alcohol-related liver disease are at an even higher risk for poor in-hospital outcomes.
“The increased risk of adverse events in CLD patients is likely to be multifactorial," wrote lead author Sedralmontaha Istanbuly, a specialist at the University of Aleppo in Syria, and colleagues. “As liver function deteriorates, anemia, coagulopathy and thrombocytopenia may contribute to bleeding. Major bleeding accounts for 12% of all deaths post PCI in a previous analysis and is associated with an increased risk of myocardial infarction, MACCE and mortality.”
The team also found that patients with CLD are more likely to have comorbidities such as thrombocytopenia, anemia, chronic pulmonary disease, coagulopathy, diabetes mellitus, drug abuse, alcohol abuse, chronic renal failure and they tended to be sicker with a higher rate of cardiac arrest, ventricular tachycardia and ventricular fibrillation.
“Our data highlight the need to consider both the severity as well as the underlying etiology of CLD when undertaking PCI," the authors wrote. "Physicians performing PCI procedures in patients with CLD should consider peri-procedural bleeding avoidance strategies such as the adoption of transradial access, minimization of the use of glycoprotein 2b/3a inhibitors and potent P2Y12 inhibitors such as ticagrelor and prasugrel."
Read the full study here.