Clinical Outcomes of Percutaneous Coronary Intervention in Amyloidosis, Sarcoidosis, and Hemochromatosis

Hussain, Bilal; Malik, Hamza; Mamas, Mamas A.; Desai, Rupak; Aggarwal, Vikas; Kumar, Gautam; Alraies, Chadi; Kalra, Ankur; Paul, Timir K.

Abstract

Background
Infiltrative diseases (ID), including amyloidosis, sarcoidosis, and hemochromatosis comprise a wide spectrum of disorders characterized by abnormal cellular infiltration in multiple organs, including the heart leading to cardiomyopathy. Data on the prognosis of underlying ID in patients undergoing percutaneous coronary intervention (PCI) have not been well studied. Our objective was to evaluate the prevalence of amyloidosis, sarcoidosis, and hemochromatosis in patients undergoing PCI and their association with post-PCI outcomes.

Methods
Data on patients admitted for PCI were gathered from the National Inpatient Sample (NIS) 2016-2020 for a retrospective analysis using respective International Classification of Diseases, Tenth Revision codes. The patients with PCI were then divided into those with and without underlying ID, which included amyloidosis, sarcoidosis, and hemochromatosis. Composite post-PCI outcomes were in-hospital mortality, intra/postprocedure stroke, and major bleeding. Multivariate logistic regression was performed for outcomes analysis.

Results
Among 2,360,860 patients admitted to undergo PCI, 7855 patients had underlying ID. The highest prevalence was observed for sarcoidosis (0.2%) followed by hemochromatosis (0.07%) and amyloidosis (0.04%). Patients who underwent PCI with ID had a higher proportion of females (40.8% vs 32.7%), African Americans (23.7% vs 9.6%), and a higher comorbidity burden. Underlying amyloidosis was associated with worse composite post-PCI outcomes (odds ratio [OR], 1.6; CI, 1.1-2.44; P = .02), including higher in-hospital mortality (OR, 1.9; CI, 1.1-3.4; P = .04), higher risk of intra/post-PCI stroke (OR, 4.0; CI, 1.1-16.0; P = .04), but not major bleeding (OR, 2.2; CI, 0.97-5.03; P = .058). In contrast, underlying sarcoidosis (OR, 1.1; CI, 0.87-1.41; P = .4) and hemochromatosis (OR, 1.18; CI, 0.77-1.8; P = .44) were not associated with composite post-PCI outcomes. Patients with amyloidosis undergoing PCI also had higher hospitalization charges ($212123 vs $141137; P = .03) and longer length of stay (8.2 vs 3.9 days; P <.001).

Conclusions
Underlying amyloidosis was associated with worse post-PCI outcomes including higher in-hospital mortality, intra/post-PCI stroke, and socioeconomic burden. Although sarcoidosis and hemochromatosis have no significant association with post-PCI outcomes, a multidisciplinary approach and future studies are needed to investigate the screening and treatment strategies in these patients.

Citation

Hussain, B., Malik, H., Mamas, M. A., Desai, R., Aggarwal, V., Kumar, G., …Paul, T. K. (2023). Clinical Outcomes of Percutaneous Coronary Intervention in Amyloidosis, Sarcoidosis, and Hemochromatosis. Journal of the Society for Cardiovascular Angiography & Interventions, Article 101267. https://doi.org/10.1016/j.jscai.2023.101267

• Journal Article Type: Article
• Acceptance Date: Dec 11, 2023
• Online Publication Date: Dec 30, 2023
• Publication Date: Dec 30, 2023
• Deposit Date: Feb 26, 2024
• Journal: Journal of the Society for Cardiovascular Angiography & Interventions
• Print ISSN: 2772-9303
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Article Number: 101267
• DOI: https://doi.org/10.1016/j.jscai.2023.101267
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2772930323013273?via%3Dihub