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.


 

AT THE 2018 CRT MEETING


As a result, he initiated his own study, looking for such cases in the New York State Inpatient Database, in which there were 1,400 patients with paraplegia or quadriplegia and more than 400,000 without these limb impairments who had presented with acute MI over the period of study. After comparing outcomes in these two groups, a subsequent analysis was performed in which each patient with paraplegia/quadriplegia was matched by propensity scoring to five patients from the database without paraplegia/quadriplegia.

Notably, patients with paraplegia/quadriplegia were found to represent a small but steady proportion of acute MI cases. With only modest variation, the rate hovered around 0.2%-0.3% of cases per year.

“The patients with paraplegia or quadriplegia tended to be somewhat younger [67 vs. 70 years of age; P less than .001], have more comorbidities, and were more likely to be enrolled in Medicare,” Dr. Dai reported.

Of patients in the database without paraplegia/quadriplegia, 56% received medical therapy alone and 14% underwent catheterization but were not revascularized. Of the 31% who were revascularized, 82% underwent PCI, and the remainder underwent CABG.

Among those with paraplegia/quadriplegia, 83.7% were managed medically and 7.2% underwent catheterization but no revascularization. Of the 9.1% who were revascularized, 7.2% underwent PCI and 1.9% underwent CABG.

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