Conference Coverage

Revascularization in paraplegics best performed with PCI


Key clinical point: In patients with paraplegia or quadriplegia, percutaneous coronary intervention should be the revascularization of choice for acute MI.

Major finding: Major adverse cardiovascular events at 30 days were lower after PCI than coronary artery bypass grafting (6% vs. 22%).

Data source: A nonrandomized retrospective analysis.

Disclosures: Dr. Dai reported no financial relationships to disclose. Source: Dai X. CRT 2018.



When evaluated with propensity scoring, the differences in outcomes between those with or without paraplegia/quadriplegia were more modest, but MACE rates after CABG remained significantly higher (8.4% vs. 3.5%; P = .02). In contrast, the difference in MACE rates after propensity matching was no longer significantly higher in the paraplegia/quadriplegia group treated with PCI (4.4% vs. 2.0%; P = .46).

When CABG was compared to PCI among those with paraplegia/quadriplegia, the rate of in-hospital mortality was almost four times higher (9.5% vs. 2.5; P less than.01). Paraplegic/quadriplegic patients treated with CABG also had longer lengths of hospital stay and incurred higher treatment costs, according to Dr. Dai.

The moderator of the session at which these data were presented, Scott Schurmer, MD, chief of cardiology at Texas Tech Health Sciences Center, Lubbock, cautioned about the limitations of propensity scoring. He also suggested that PCI, based on concern for potential comorbidities in patients with paraplegia and quadriplegia, would likely be the choice of many physicians even without these data.

Dr. Dai reported no financial relationships to disclose.

SOURCE: Dai X. CRT 2018.

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