Bristol Heart Institute, Bristol, United Kingdom; Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
Am J Cardiol. 2022 May 15;171:40-48. doi: 10.1016/j.amjcard.2022.01.045. Epub 2022 Mar 15.
There are limited data on the clinical outcomes of percutaneous coronary intervention (PCI) in patients with acquired immunosuppression who are frequently underrepresented in clinical trials. All PCI procedures between October 2015 and December 2018 in the Nationwide Inpatient Sample were retrospectively analyzed, stratified by immunosuppression status. Multivariable logistic regression models were performed to examine (1) the association between immunosuppression status and in-hospital outcomes, expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CIs) and (2) predictors of mortality among patients with severe acquired immunosuppression. In this contemporary analysis of nearly 1.5 million PCI procedures, approximately 4% of patients who underwent PCI had acquired immunosuppression. Of these, chronic steroid use accounted for approximately half of the cohort who underwent PCI who had acquired immunosuppression, with the remainder divided between hematologic cancer, solid organ active malignancy, and metastatic cancer, with the latter group having the highest rates of composite of in-hospital mortality or stroke (9.3%) (mortality 7.5% and acute ischemic stroke 2.4%). In conclusion, immunosuppression was independently associated with increased adjusted odds of adverse clinical outcomes, specifically mortality or stroke (aOR 1.11, 95% CI 1.06 to 1.15, p <0.001) and in-hospital mortality (aOR 1.21, 95% CI 1.13 to 1.29, p <0.001), with outcomes dependent on the cause of immunosuppression.
在经常在临床试验中代表性不足的获得性免疫抑制患者中，经皮冠状动脉介入治疗（PCI）的临床结果数据有限。回顾性分析了 2015 年 10 月至 2018 年 12 月全国住院患者样本中所有 PCI 手术，并按免疫抑制状态分层。多变量逻辑回归模型用于检查（1）免疫抑制状态与住院期间结局之间的关系，以调整后的优势比（aOR）表示，95%置信区间（CI）和（2）严重获得性免疫抑制患者死亡的预测因素。在这项对近 150 万例 PCI 手术的当代分析中，约有 4%接受 PCI 的患者存在获得性免疫抑制。其中，慢性类固醇使用约占接受 PCI 治疗的获得性免疫抑制患者的一半，其余患者分为血液系统恶性肿瘤、实体器官活动性恶性肿瘤和转移性癌症，后者的复合院内死亡率或卒中发生率最高（9.3%）（死亡率为 7.5%，急性缺血性卒中为 2.4%）。总之，免疫抑制与不良临床结局（特别是死亡率或卒中（aOR 1.11，95%CI 1.06 至 1.15，p<0.001）和住院死亡率（aOR 1.21，95%CI 1.13 至 1.29，p<0.001）的调整后优势比独立相关），其结果取决于免疫抑制的原因。
