Adverse Events After Catheter-Based Procedures in Congenital Heart Disease
What are the factors associated with major adverse events (MAEs) after cardiac catheterization in adolescents and adults with congenital heart disease (CHD)?
Hospitals that perform catheterizations on children or adults with CHD were invited to participate in the Improving Pediatric and Adult Congenital Treatment (IMPACT) database, a National Cardiovascular Data Registry. The registry contains congenital catheterization data from over 87 hospitals in the United States. Demographics, pre-procedure, and procedural variables were collected for patients over age 10. Multivariable logistic regression was used to identify significant predictors of MAEs, a composite of death, urgent surgery, or procedure due to a catheterization complication, transfusion, embolic stroke, tamponade, extracorporeal membrane oxygenation or ventricular assist device placement, and device embolization, malposition, or thrombosis requiring surgical intervention. A risk score was built based on the effect sizes of each predictor and validated in a split sample.
A MAE occurred in 686 (2.5%) of the 27,293 index procedures meeting inclusion criteria. The independent multivariate predictors of MAEs were older age, pre-procedural anticoagulation use, renal disease, lower hemoglobin, lower oxygen saturation, nonelective procedure, higher index procedure risk, and having had no prior cardiac procedures. Being underweight or overweight had borderline significance and was added to the model. The C-statistic for the model was robust at 0.787 in the derivation and 0.773 in the validation cohort.
The authors concluded that factors predicting adverse events after cardiac catheterization in adolescents and adults with CHD are different than in the general population.
This study reports a set of new risk factors that are strong predictors of MAEs after cardiac catheterizations in adolescents and adults with CHD. Of note, independent risk factors for MAEs were different than those described in either pediatric population or adults with acquired heart disease. Procedural variables, nonelective and more complex procedure, no history of prior catheterizations or cardiac surgery had the strongest predictive effect, followed by factors related to patient medical complexity (i.e., history of renal disease, pre-procedural anticoagulant use, lower hemoglobin, older age, being underweight, and increased severity of congenital disease). It appears that this model can be useful to individualize the risk/benefit discussion in this population prior to a catheterization, while additional studies are conducted to validate this risk score in prospective multicenter databases.
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