Subject(s)
Carcinoma, Renal Cell , Heart Transplantation , Kidney Neoplasms , Melanoma , Humans , Nivolumab/adverse effects , Immune Checkpoint Inhibitors , Carcinoma, Renal Cell/drug therapy , Melanoma/drug therapy , Melanoma/pathology , Melanoma/secondary , Kidney Neoplasms/drug therapy , Kidney Neoplasms/pathology , Heart Transplantation/adverse effectsABSTRACT
OBJECTIVES: To assess the prognostic significance of high vs. low grade coronary artery ectasia (CAE) and the impact of antithrombotic or anticoagulant therapy on adverse cardiac outcomes. BACKGROUND: There is paucity of knowledge on the impact of angiographic characteristics in CAE or that of antithrombotic or anticoagulant therapy on outcomes. METHODS AND RESULTS: In this retrospective study, we reviewed angiograms and medical records of all cases of confirmed CAE (2001-2011). Extent of CAE was categorized using the Markis classification. Types 1 and 2 were categorized as high-grade and types 3 and 4 as low-grade CAE. Angiographic flow was recorded as normal or sluggish (Subject(s)
Acute Coronary Syndrome/prevention & control
, Anticoagulants/therapeutic use
, Coronary Aneurysm/drug therapy
, Coronary Angiography
, Coronary Vessels/drug effects
, Fibrinolytic Agents/therapeutic use
, Acute Coronary Syndrome/diagnostic imaging
, Acute Coronary Syndrome/mortality
, Aged
, Aged, 80 and over
, Anticoagulants/adverse effects
, Blood Flow Velocity
, Coronary Aneurysm/diagnostic imaging
, Coronary Aneurysm/mortality
, Coronary Aneurysm/physiopathology
, Coronary Circulation
, Coronary Vessels/diagnostic imaging
, Coronary Vessels/physiopathology
, Dilatation, Pathologic
, Electronic Health Records
, Female
, Fibrinolytic Agents/adverse effects
, Humans
, Incidence
, Male
, Middle Aged
, Predictive Value of Tests
, Prevalence
, Retrospective Studies
, Risk Factors
, Severity of Illness Index
, Treatment Outcome
ABSTRACT
INTRODUCTION: Patients with end-stage liver disease (ESLD) awaiting transplant are at increased risk of bleeding. Nevertheless, these patients routinely undergo cardiac catheterization for various indications. Safety and outcomes of cardiac catheterization in these patients are not well reported. METHODS: In a case-control study 43 patients with ESLD who underwent angiography for liver transplant work-up were compared to 43 age and gender-matched controls with no liver dysfunction. In-hospital outcomes and procedural variables were compared. RESULTS: Patients with ESLD had a lower baseline hemoglobin (12.1 ± 2.1 vs. 13.7 ± 1.8, P < 0.0005), lower platelet counts (86.8 ± 66 vs. 247 ± 80, P < 0.0001) and higher international normalized ratio (INR) (1.4 ± 0.2 vs. 1.1 ± 0.2, P < 0.0001) than controls. Among ESLD group, five (11.6%) patients received platelet transfusions, one received blood transfusion, and three patients (7%) with INR > 1.6 received fresh frozen plasma (FFP) compared with none in the control group. Smaller size (four French) vascular sheaths were used more frequently in the group with ESLD (16% vs. 4%, P = 0.04). There were no significant vascular or bleeding complications in either group. CONCLUSIONS: Elective cardiac catheterization can be safely performed in patients with ESLD with outcomes (vascular and bleeding complications, length of hospital stay and in-hospital mortality) similar to patients without liver disease despite significant thrombocytopenia and elevated INR in patients with ESLD. Practices such as platelet transfusion for platelets <60,000 µL, prophylactic FFP transfusion for INR ≥ 1.6, less frequent use of antiplatelet therapy and more frequent use of smaller vascular sheaths may have contributed to the safety of cardiac catheterization in ESLD patients.
