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The Morbidity and Mortality Risks following Percutaneous Coronary Interventions in Cirrhosis

Yasir Alazzawi*, Yasir Alabboodi, Matthew Fasullo, Ali Ridha and Tarek Naguib

Background: The prevalence of coronary artery disease in cirrhotic population is estimated to be low and the risk of bleeding in those who had percutaneous catheterization interventions (PCI) is not well studied yet. Our aim in this study is to determine the morbidity and mortality risks in cirrhotic patient undergoing PCI.

Methods: We performed a retrospective analysis using the National Inpatient Sample (NIS) database for 2010. The NIS is the largest publicly available inpatient health care database in the United States. It contains data from more than 7 million hospital stays each year. People with Percutaneous coronary intervention (PCI) related admissions and a history of cirrhosis diagnosis were placed in the case group. Equivalent number of people with PCI related admissions and no history of cirrhosis were identified randomly and Case-Control (PCI with cirrhosis vs. PCI without cirrhosis) design is used. All genders, race was with age of 18-year-old and above was included. A binary multivariate Logistic regression statistical test was used to examine the probability difference adjusted odd ratio. IBM SPSS Statistics for Windows was used to execute the analysis. A confidence interval (CI) of 95% and P value less than 0.05 were determined to define significance.

Results: A total of 1218 of PCI related admissions were identified. 609 PCI related admissions with cirrhosis (Cases group) and equivalent number of 609 admissions with PCI and no cirrhosis (Control group) were randomly selected. 83.5% of the cohort represented by white race followed by Hispanic and African-American percentages of 10% and 6.5% respectively. The mean age of the cohort was 60 years, 54% represented by male race. The mean length of stay was 1.06 in the non-cirrhosis group compared to the 1.65 days in the cirrhosis group. Tables 1 and 2 (0.3%) out of 609 PCI related admission and no history of cirrhosis group had an Upper Gastrointestinal bleeding (UGIB) Vs. 11 (1.8%) in the PCI related admission with history of cirrhosis group. Inpatient mortality in the PCI+ non Cirrhosis group was 0.3% vs. 1.8% in the PCI and Cirrhosis group.

The probability of dying during hospitalization for PCI related admission and have history of cirrhosis is 5 times higher than having a PCI without history of Cirrhosis with an adjusted odd ratio of 5.5(P-Value 0.026).

Conclusion: There is a significantly higher risk of gastrointestinal bleeding and mortality in cirrhotic patients compared to the non-cirrhotic patients who underwent PCI.