Clinical Outcomes in ACS With Cholesterol Embolization Syndrome Post-PCI

Patients with acute coronary syndrome (ACS) who developed cholesterol embolization syndrome (CES) after percutaneous coronary intervention (PCI) were associated with having poor clinical outcomes, high health care utilization, and associated costs. The study findings were presented at the American Heart Association (AHA) Scientific Sessions 2021, held virtually from November 13 to 15, 2021.

PCI increases risk for CES among patients with ACS. These patients account for approximately 70% of all iatrogenic cholesterol embolization cases. Despite this clinical association, it remains unclear what the clinical outcomes of CES post-PCI are and what the burden on the health care system is at a national level.

In order to better understand the consequences of CES, researchers from University College Hospital, Ibadan in Nigeria sourced nationwide data from the National In-Patient Sample collected between 2016 and 2018. Patients (n=365) with ACS who developed CES post-PCI were assessed for rates of acute kidney injury (AKI), sepsis, cardiogenic shock, and in-hospital mortality as well as length of stay and health care costs. Trends were adjusted for sociodemographic parameters, clinical features, and hospital-level factors.

Patients were 48% women, had a mean age of 69.5 years, and 76.7% were White.

AKI occurred among 32.9%, sepsis among 6.8%, and cardiogenic shock among 4.1%. The in-hospital mortality rate was 11%.

These patients stayed in the hospital for an average of 8.2 days and associated with a mean health care cost of $99,958.02.

This study was associated with the limitations all studies using information from databases have, the possibility of missing data and including inaccurate information.

The study found that patients with ACS who develop CES post-PCI were associated with poor outcomes, including an in-hospital mortality rate greater than 10%. In addition, these patients had high health care resource utilization. Additional studies are needed to better assess risk factors and intervention strategies to mitigate these risks.

Reference

Eromosele OB, Asemota I, Safiriyu I, et al. Cholesterol embolization syndrome among patients with acute coronary syndrome post-percutaneous coronary intervention: a national inpatient analysis. Presented at: AHA Scientific Sessions 2021. Abstract 9578