Pulmonary Hypertension Mortality Following Cardiac Catheterization
Higher pulmonary hypertension case volume may reduce the risk for mortality following cardiac catheterization.
Children and young adults up to 21 years of age who have pulmonary hypertension (PH) have a high risk for adverse events during and following cardiac catheterization, according to a registry analysis published in the Journal of the American Heart Association.
Conversely, when patients underwent catheterization at centers with high PH case volumes, the risk for adverse events was lower.
Using data submitted to the IMPACT (Improving Adult and Congenital Treatment) registry, investigators evaluated the risk for adverse outcomes (eg, mortality, cardiac arrest, new arrhythmia, need for mechanical circulatory support) in 7729 children and young adults (age 0-21 years) with PH who underwent catheterization at 77 different centers. Patients had either idiopathic PH (n=2135), PH-associated congenital heart disease (n=3615), PH with cardiomyopathy (n=553), PH after orthotopic heart transplant (n=1339), or pulmonary vein stenosis and PH (n=469).
Of the participants included in the analysis, a total of 8111 catheterization procedures were performed. The observed risk for the composite outcome — death on the day of catheterization or the day following catheterization and cardiac arrest or start of extracorporeal membrane oxygenation — was 1.4%. In addition, the overall risk for mortality prior to discharge was 5.2%. Prematurely born neonates as well as nonpremature infants had an increased risk for the composite outcome with catheterization.
The use of inotropes before catheterization and lower systemic arterial saturation were also associated with an increased mortality risk in this subgroup. There was an increased risk for the composite outcome with increasing pulmonary artery pressures and increasing pulmonary vascular resistance in all patients included in the analysis (P <.0001 for both). Those whose catheterization was performed by an experienced interventionalist had a significantly reduced risk for the composite outcome (odds ratio, 0.8 per 10 procedures; P =.002).
Because of the study's observational design, the researchers were unable to determine causative factors associated with catheterization and rates of adverse events. In addition, variations in clinical practice could not be accounted for, limiting the findings to an overall viewpoint of adverse event risk in this patient population.
The investigators suggested the findings are “important for preprocedural evaluation of risk and benefit” in pediatric and young adult patients with PH undergoing catheterization.
O'Byrne ML, Kennedy KF, Kanter JP, Berger JT, Glatz AC. Risk factors for major early adverse events related to cardiac catheterization in children and young adults with pulmonary hypertension: an analysis of data from the IMPACT (Improving Adult and Congenital Treatment) registry. J Am Heart Assoc. 2018;7(5):e008142.