Abstract 16280: Long-Term Outcomes of Percutaneous Coronary Intervention in Patients With Cirrhosis or End-Stage Liver Disease
Introduction: Patients with cirrhosis and coronary artery disease (CAD) are at high risk for surgical revascularization and are often referred for percutaneous coronary intervention (PCI). If not adequately revascularized, patients may be denied listing for liver transplantation. PCI in the cirrhotic population has inherent risks, including but not limited to bleeding and acute kidney injury (AKI) due to coagulopathies, cytopenias, varices, and dynamic renal perfusion. Data on long term outcomes of PCI in cirrhotics are lacking.
Hypothesis: PCI in cirrhotics is associated with a high risk of long term complications.
Methods: A single-institution retrospective cohort study was performed. Patients with angiographically significant CAD and cirrhosis were identified from a database of left heart catheterizations (LHC) in the University of Pennsylvania Health System between 1/1/2007-12/31/2015. Short and long term outcomes were obtained from the electronic medical record. Patients or families were contacted directly if they were lost to follow up.
Results: There were 51 successful PCI events in 43 patients, and 34 LHCs in 27 patients identifying significant CAD ultimately treated with medical management alone. Eleven out of 43 patients in the PCI group were listed for liver transplant, of which 4 received transplant. Eight out of 27 in the medical management group were listed, of which 6 received transplant. Complete revascularization occurred in only 3 patients, but there were no peri-transplant cardiovascular events in either group. Overall PCI-related complication rates during up to 1 year of followup were high (53%), including major bleeding (32%) on dual antiplatelet therapy (DAPT), post-PCI AKI (29%), and hematoma (4%). The medical management group had significantly fewer events (23% vs. 53%, p < 0.01 by Fischer exact test), including major bleeding (19%), post-LHC AKI (6%), and hematoma (0%). PCI complications showed a trend towards association with Child-Pugh Class (A: 29%, B: 62%, C: 80%, p = 0.077).
Conclusions: PCI in patients with cirrhosis is associated with a high risk of complications related to severity of liver disease and use of DAPT. Transplantation was successfully accomplished even in the absence of complete revascularization.
Author Disclosures: D.Y. Lu: None. M.D. Saybolt: None. D.H. Kiss: None. W.H. Matthai: None. K.A. Forde: None. J. Giri: None. R.L. Wilensky: None.
- © 2016 by American Heart Association, Inc.