The influence of Elixhauser comorbidity index on percutaneous coronary intervention outcomes
Jessica Potts PhD
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
These authors contributed equally to manuscript.Search for more papers by this authorVinayak Nagaraja MBBS, MS, MMed (Clin Epi), FRACP
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Department of Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
These authors contributed equally to manuscript.Search for more papers by this authorJassim Al Suwaidi
Weill Cornell Medical School, Qatar, Department of Cardiology, Hamad General Hospital, Doha, Qatar
Search for more papers by this authorSalvatore Brugaletta MD, PhD
Division of Cardiology, Cardiovascular Institute, Hospital Clinic, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
Search for more papers by this authorSara C. Martinez MD, PhD
Division of Cardiology, Providence St. Peter Hospital, Washington
Search for more papers by this authorChadi Alraies
Division of Cardiology, Wayne State University, Detroit Medical Center Heart Hospital, Detroit, Michigan
Search for more papers by this authorDavid Fischman
Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Search for more papers by this authorChun Shing Kwok
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Search for more papers by this authorJim Nolan FRCP
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Search for more papers by this authorDarren Mylotte
Department of Cardiology, University Hospital Galway, Galway, Ireland
Search for more papers by this authorCorresponding Author
Mamas A. Mamas FRCP
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Institute of Population Health Sciences, University of Manchester, Manchester, England, United Kingdom
Correspondence
Mamas A. Mamas, Professor of Interventional Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent ST4 7QB, United Kingdom.
Email: [email protected]
Search for more papers by this authorJessica Potts PhD
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
These authors contributed equally to manuscript.Search for more papers by this authorVinayak Nagaraja MBBS, MS, MMed (Clin Epi), FRACP
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Department of Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
These authors contributed equally to manuscript.Search for more papers by this authorJassim Al Suwaidi
Weill Cornell Medical School, Qatar, Department of Cardiology, Hamad General Hospital, Doha, Qatar
Search for more papers by this authorSalvatore Brugaletta MD, PhD
Division of Cardiology, Cardiovascular Institute, Hospital Clinic, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
Search for more papers by this authorSara C. Martinez MD, PhD
Division of Cardiology, Providence St. Peter Hospital, Washington
Search for more papers by this authorChadi Alraies
Division of Cardiology, Wayne State University, Detroit Medical Center Heart Hospital, Detroit, Michigan
Search for more papers by this authorDavid Fischman
Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Search for more papers by this authorChun Shing Kwok
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Search for more papers by this authorJim Nolan FRCP
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Search for more papers by this authorDarren Mylotte
Department of Cardiology, University Hospital Galway, Galway, Ireland
Search for more papers by this authorCorresponding Author
Mamas A. Mamas FRCP
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, and Academic Dept of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, England, United Kingdom
Institute of Population Health Sciences, University of Manchester, Manchester, England, United Kingdom
Correspondence
Mamas A. Mamas, Professor of Interventional Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent ST4 7QB, United Kingdom.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Clinical outcomes with respect to the evolution of comorbidity burden in national cohorts of patients undergoing PCI have not been reported.
Objectives
We sought to explore the association between comorbidity burden and periprocedural outcomes in patients treated with PCI in the National Inpatient Sample.
Methods
6,601,526 PCI procedures were identified between 2004 and 2014 and comorbidities were defined by the Elixhauser classification system (ECS) consisting of 30 comorbidity measures. Endpoints included in-hospital mortality, periprocedural complications, length of stay and cost. Patients were classified based on their ECS in five categories (ECS I < 0, ECS II = 0, ECS III = 1–5, ECS IV = 6–13, and ECS V ≥ 14).
Results
Patients with a score over 13 had a fivefold increase in the odds of mortality (OR: 5.13, 95% CI: 4.76–5.54), major bleeding (OR: 11.46, 95% CI: 10.66–12.33) and doubled the hospitalization costs ($31,452 vs $17.566).
Conclusions
Our study of over six million PCI procedures demonstrates that patients with the greatest comorbid burden (as defined by an ECS of >13) have a fivefold increase risk of in-hospital mortality, a fourfold increase in in-hospital periprocedural complications and an 11-fold increase in major bleeding events once differences in baseline patient characteristics are adjusted for. In addition, ECS significantly impacts the length of stay and doubles the healthcare costs. Comorbid burden is an important predictor of poor outcomes after PCI and should be considered as part of the decision-making processes in patients undergoing PCI.
Supporting Information
| Filename | Description |
|---|---|
| CCD_28072-sup-0001-tableS1.docxWord 2007 document , 19.5 KB |
Supplementary Table 1 ICD-9-CM codes for post procedural complications Supplementary Table 2: Odds ratios for a unit increase for both the continuous van Walraven Elixhauser scores and the number of Elixhauser comorbidities. Supplementary Table 3: Elixhauser classification system and point system Supplementary Table 4: Multivariable logistic regression results for the association between in-hospital mortality and complications and categorized number of Elixhauser comorbidities |
| CCD_28072-sup-0002-FigureS1.tifTIFF image, 336.9 KB | Figure S1 Flow diagram of included/excluded records |
| CCD_28072-sup-0003-FigureS2.tifTIFF image, 215.3 KB | Figure S2 Distribution of categorized number of Elixhauser comorbidities for each included year of the study |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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