Clots and bleeds: the outcomes of percutaneous coronary intervention in hemophilia patients with acute coronary syndrome

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-10-17 DOI:10.1002/ccd.31269

Michel Al Achkar MD, Georges Khattar MD, Samer Asmar MD, Michel El Khoury MD, Fares Saliba MD, MBA, Laurence Aoun MD, Ibrahim Al Saidi MD, Ghada Araji MD, Salman Khan MD, Elie Bou Sanayeh MD, MBA, Mitchell Weinberg MD, MBA, Alexander Bershadskiy MD

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Abstract

Background

Hemophilia is a disease characterized by a high risk of bleeding. With advances in treatment, life expectancy and aging-associated diseases such as coronary artery disease have increased. Our primary objective is to assess for major adverse outcomes, mortality, and length of hospital stay in individuals with hemophilia presenting for acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI).

Methods

Our retrospective cohort study analyzed data from the Nationwide Inpatient Sample Database (NIS) for 2018 to investigate the outcomes of ACS management with PCI in adults with and without hemophilia. We used ICD-10 codes to exclude patients with significant comorbidities and identify those with ACS undergoing PCI. Propensity score matching and multivariable logistic regression were employed to account for over 20 baseline characteristics, mitigating confounding factors.

Results

The incidence of gastrointestinal bleeding (11.0% vs. 2.8%, p < 0.001), hemorrhagic stroke (10.0% vs. 1.4%, p < 0.001), and retroperitoneal hemorrhage (5.6% vs. 1.4%, p < 0.001) was significantly higher in individuals with hemophilia undergoing PCI compared to those without hemophilia. Additionally, venous thromboembolism (VTE) incidence was notably higher in the hemophilia cohort (6.6% vs. 2.4%, p = 0.027). The hemophilia cohort also experienced a higher mortality rate (7.1% vs. 3.3%, p = 0.037) and longer hospital stays.

Conclusion

Patients with hemophilia undergoing PCI are at a significantly greater risk of adverse events, increased mortality, and longer hospital stays than the general population. To mitigate the risk of unfavorable outcomes, it is crucial to ensure adequate replenishment of coagulation factors and establish close collaboration between cardiologists and hematologists.

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血栓与出血：急性冠状动脉综合征血友病患者经皮冠状动脉介入治疗的结果。

背景：血友病是一种出血风险很高的疾病。随着治疗的进步，预期寿命和冠状动脉疾病等与衰老相关的疾病也在增加。我们的主要目的是评估因急性冠状动脉综合征（ACS）就诊并接受经皮冠状动脉介入治疗（PCI）的血友病患者的主要不良后果、死亡率和住院时间：我们的回顾性队列研究分析了2018年全国住院患者样本数据库（NIS）的数据，以调查血友病成人和非血友病成人接受PCI治疗ACS的结果。我们使用ICD-10编码排除了有重大合并症的患者，并确定了接受PCI治疗的ACS患者。我们采用倾向评分匹配和多变量逻辑回归来考虑 20 多个基线特征，以减少混杂因素：结果：胃肠道出血的发生率（11.0% vs. 2.8%，P 结论：接受 PCI 治疗的血友病患者的胃肠道出血发生率较高：与普通人群相比，接受 PCI 治疗的血友病患者发生不良事件、死亡率升高和住院时间延长的风险明显更高。为了降低不良后果的风险，必须确保补充足够的凝血因子，并在心脏病专家和血液专家之间建立密切的合作关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.