Heart & lung : the journal of critical care · 2026
Impact of pulmonary hypertension on long-term clinical outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndrome: Results from a large PCI registry.
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Awad Ali, Hamza Mohamad, Rayes Abdullah, Al Haly Basam, Kidess George G, Akkawi Mohammad, Basit Jawad, Inampudi Jyothik Varun, Alkhas Chmsalddin, Alkatib Aziz, Alraies M Chadi
Аннотация
BACKGROUND: Pulmonary hypertension (PH) may compromise hemodynamic tolerance during acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Current ACS risk tools do not incorporate pulmonary hypertension status and procedure-level outcome data remain limited.
OBJECTIVES: To determine whether pre-existing PH independently predicts adverse in-hospital and post-discharge outcomes in ACS patients undergoing PCI.
METHODS: Single-center retrospective cohort study of consecutive PCI procedures for ACS (2012 to 2017) using an institutional PCI Registry. The primary composite outcome included in-hospital death, cardiogenic shock, or significant arrhythmia. Secondary endpoints included AKI, major bleeding, in-hospital HF, and post-discharge events at 30 days, 6 months, and 1 year. Multivariable logistic regression adjusted for sex, hypertension, hyperlipidemia, diabetes, smoking, prior CAD, peripheral artery disease, CKD, prior TIA/stroke, and anemia.
RESULTS: Among 3022 patients, 158 (5.23%) had PH. PH patients were older (67.0 vs. 64.8 years, p = 0.023) with greater comorbidity burden. After adjustment, PH independently predicted AKI (aOR 1.72; 95% CI 1.01 to 2.93; p = 0.046), cardiogenic shock (aOR 3.32; 95% CI 1.59 to 6.95; p = 0.001), and in-hospital HF (aOR 2.15; 95% CI 1.15 to 4.02; p = 0.017). At 6 months, PH was associated with HF readmission (aOR 2.12; p = 0.024) and stroke (aOR 4.28; p = 0.027). Adjusted mortality, recurrent ACS, and reintervention rates were similar across all time points.
CONCLUSIONS: Among ACS patients undergoing PCI, PH identifies a high-risk phenotype characterized by congestion-related and hemodynamic complications rather than atherothrombotic recurrence. The temporal risk evolution suggests distinct pathophysiological mechanisms requiring targeted interventions.
OBJECTIVES: To determine whether pre-existing PH independently predicts adverse in-hospital and post-discharge outcomes in ACS patients undergoing PCI.
METHODS: Single-center retrospective cohort study of consecutive PCI procedures for ACS (2012 to 2017) using an institutional PCI Registry. The primary composite outcome included in-hospital death, cardiogenic shock, or significant arrhythmia. Secondary endpoints included AKI, major bleeding, in-hospital HF, and post-discharge events at 30 days, 6 months, and 1 year. Multivariable logistic regression adjusted for sex, hypertension, hyperlipidemia, diabetes, smoking, prior CAD, peripheral artery disease, CKD, prior TIA/stroke, and anemia.
RESULTS: Among 3022 patients, 158 (5.23%) had PH. PH patients were older (67.0 vs. 64.8 years, p = 0.023) with greater comorbidity burden. After adjustment, PH independently predicted AKI (aOR 1.72; 95% CI 1.01 to 2.93; p = 0.046), cardiogenic shock (aOR 3.32; 95% CI 1.59 to 6.95; p = 0.001), and in-hospital HF (aOR 2.15; 95% CI 1.15 to 4.02; p = 0.017). At 6 months, PH was associated with HF readmission (aOR 2.12; p = 0.024) and stroke (aOR 4.28; p = 0.027). Adjusted mortality, recurrent ACS, and reintervention rates were similar across all time points.
CONCLUSIONS: Among ACS patients undergoing PCI, PH identifies a high-risk phenotype characterized by congestion-related and hemodynamic complications rather than atherothrombotic recurrence. The temporal risk evolution suggests distinct pathophysiological mechanisms requiring targeted interventions.