Prediction of adverse events after catheter-based procedures in adolescents and adults with congenital heart disease in the IMPACT registry
| Autor: | Ami B. Bhatt, Jamil Aboulhosn, Aimee K. Armstrong, David G. Nykanen, Kevin F. Kennedy, Ada C. Stefanescu Schmidt |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Heart Defects Congenital Male Cardiac Catheterization medicine.medical_specialty Adolescent Heart disease medicine.medical_treatment Population 030204 cardiovascular system & hematology Logistic regression Young Adult 03 medical and health sciences Extracorporeal Membrane Oxygenation Postoperative Complications 0302 clinical medicine Risk Factors medicine Extracorporeal membrane oxygenation Humans Registries 030212 general & internal medicine education Intensive care medicine Adverse effect Aged Cardiac catheterization education.field_of_study Framingham Risk Score business.industry Middle Aged medicine.disease United States Ventricular assist device Emergency medicine Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 38:2070-2077 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehx200 |
| Popis: | Aims We sought to identify factors associated with major adverse events (MAE) after cardiac catheterization in adolescents and adults with congenital heart disease (CHD), and create the first model to individualize risk discussions in this growing population. Methods and results Improving Pediatric and Adult Congenital Treatment (IMPACT), a National Cardiovascular Data 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 MAE, 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 MAE were older age, pre-procedural anticoagulation use, renal disease, lower haemoglobin, lower oxygen saturation, non-elective 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. Conclusion The factors predicting adverse events after cardiac catheterization in adolescents and adults with CHD are different than in the general population. Validation of this model in other national or multi-institutional datasets is the next step. |
| Databáze: | OpenAIRE |
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