Incidence and outcomes of early percutaneous coronary intervention after isolated valve surgery

Fahad Alqahtani, Khaled Ziada, Charanjit Rihal, Mohamad Alkhouli

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Coronary ischemia requiring early percutaneous coronary intervention (PCI) is a rare but serious complication of isolated valve surgery. We sought of assess the incidence, predictors and outcomes of early PCI after isolated valve surgery using the national inpatient sample. Methods: Patients who underwent isolated aortic valve replacement (AVR), isolated mitral valve repair (MVr) or replacement (MVR) between 2003 and 2014 were identified. Patients who had early postoperative PCI were compared with patients who did not require PCI. Primary end point was in-hospital mortality. Secondary endpoints were complications, length-of-stay and cost. Results: Among the 135,611 included patients, 1,074 (0.8%) underwent PCI prior to discharge. Unadjusted in-hospital mortality was higher in patients requiring early PCI following AVR (11.2 vs. 3.1%), MVR (24.1 vs. 5.5%), and MVr (22.4 vs. 2.5%) (P < 0.001) compared with patients not requiring PCI. Postoperative PCI remained independently associated with higher mortality after adjusting for demographics, comorbidities and hospital characteristics (adjusted OR [aOR] = 3.74, 95%CI 2.70–5.17 for AVR, aOR = 6.10, 95%CI 4.53–8.23 for MVR, and aOR = 9.90, 95%CI 7.22–13.58 for MVr). Patients undergoing PCI had higher incidences of stroke, acute kidney injury, infectious complications, higher hospital charges, and longer hospitalizations. Age, robotic-assisted surgery, and chronic renal failure were independent predictors of needing early postoperative PCI. Conclusions: Early PCI after isolated aortic or mitral valve surgery is rare but is associated with substantial in-hospital morbidity, mortality, and cost. Further studies are needed to identify preventable causes, and optimal management strategies of this serious complication.

Original languageEnglish (US)
Pages (from-to)583-589
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number4
DOIs
StatePublished - Mar 1 2019

Fingerprint

Percutaneous Coronary Intervention
Incidence
Aortic Valve
Mitral Valve
Hospital Mortality
Hospital Charges
Hospital Costs
Robotics
Acute Kidney Injury
Chronic Kidney Failure
Comorbidity
Inpatients
Length of Stay
Hospitalization
Ischemia
Stroke
Demography
Morbidity
Costs and Cost Analysis
Mortality

Keywords

  • aortic valve replacement
  • mitral valve repair
  • mitral valve replacement
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Incidence and outcomes of early percutaneous coronary intervention after isolated valve surgery. / Alqahtani, Fahad; Ziada, Khaled; Rihal, Charanjit; Alkhouli, Mohamad.

In: Catheterization and Cardiovascular Interventions, Vol. 93, No. 4, 01.03.2019, p. 583-589.

Research output: Contribution to journalArticle

Alqahtani, Fahad ; Ziada, Khaled ; Rihal, Charanjit ; Alkhouli, Mohamad. / Incidence and outcomes of early percutaneous coronary intervention after isolated valve surgery. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 93, No. 4. pp. 583-589.
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AU - Ziada, Khaled

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AU - Alkhouli, Mohamad

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AB - Background: Coronary ischemia requiring early percutaneous coronary intervention (PCI) is a rare but serious complication of isolated valve surgery. We sought of assess the incidence, predictors and outcomes of early PCI after isolated valve surgery using the national inpatient sample. Methods: Patients who underwent isolated aortic valve replacement (AVR), isolated mitral valve repair (MVr) or replacement (MVR) between 2003 and 2014 were identified. Patients who had early postoperative PCI were compared with patients who did not require PCI. Primary end point was in-hospital mortality. Secondary endpoints were complications, length-of-stay and cost. Results: Among the 135,611 included patients, 1,074 (0.8%) underwent PCI prior to discharge. Unadjusted in-hospital mortality was higher in patients requiring early PCI following AVR (11.2 vs. 3.1%), MVR (24.1 vs. 5.5%), and MVr (22.4 vs. 2.5%) (P < 0.001) compared with patients not requiring PCI. Postoperative PCI remained independently associated with higher mortality after adjusting for demographics, comorbidities and hospital characteristics (adjusted OR [aOR] = 3.74, 95%CI 2.70–5.17 for AVR, aOR = 6.10, 95%CI 4.53–8.23 for MVR, and aOR = 9.90, 95%CI 7.22–13.58 for MVr). Patients undergoing PCI had higher incidences of stroke, acute kidney injury, infectious complications, higher hospital charges, and longer hospitalizations. Age, robotic-assisted surgery, and chronic renal failure were independent predictors of needing early postoperative PCI. Conclusions: Early PCI after isolated aortic or mitral valve surgery is rare but is associated with substantial in-hospital morbidity, mortality, and cost. Further studies are needed to identify preventable causes, and optimal management strategies of this serious complication.

KW - aortic valve replacement

KW - mitral valve repair

KW - mitral valve replacement

KW - percutaneous coronary intervention

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