Key result
Hemophilia during PCI for ACS is linked to ~115% higher mortality and increased GI bleeding.
Why the study?
As life expectancy in hemophilia has increased alongside aging-associated coronary artery disease, the outcomes of PCI for ACS in this high bleeding-risk population needed assessment.
Do patients with hemophilia undergoing PCI for ACS have higher rates of adverse outcomes, mortality, and longer hospital stays compared to those without hemophilia?
Cohort
Yes
Do patients with hemophilia undergoing PCI for ACS have higher rates of adverse outcomes, mortality, and longer hospital stays compared to those without hemophilia?
Absolute Event Rate: 7.1% vs 3.3%
p-value: p=0.037
Patients with hemophilia undergoing PCI for ACS face significantly higher risks of mortality, major bleeding, and VTE compared to the general population, highlighting the need for specialized multidisciplinary care.
Hemophilia patients undergoing PCI may warrant heightened bleeding vigilance; this Level 3 cohort finding leaves open prospective confirmation of management strategies.
BACKGROUND: Hemophilia is a disease characterized by a high risk of bleeding. With advances in treatment, life expectancy and aging-associated diseases such as coronary artery disease have increased. Our primary objective is to assess for major adverse outcomes, mortality, and length of hospital stay in individuals with hemophilia presenting for acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI). METHODS: Our retrospective cohort study analyzed data from the Nationwide Inpatient Sample Database (NIS) for 2018 to investigate the outcomes of ACS management with PCI in adults with and without hemophilia. We used ICD-10 codes to exclude patients with significant comorbidities and identify those with ACS undergoing PCI. Propensity score matching and multivariable logistic regression were employed to account for over 20 baseline characteristics, mitigating confounding factors. RESULTS: The incidence of gastrointestinal bleeding (11.0% vs. 2.8%, p < 0.001), hemorrhagic stroke (10.0% vs. 1.4%, p < 0.001), and retroperitoneal hemorrhage (5.6% vs. 1.4%, p < 0.001) was significantly higher in individuals with hemophilia undergoing PCI compared to those without hemophilia. Additionally, venous thromboembolism (VTE) incidence was notably higher in the hemophilia cohort (6.6% vs. 2.4%, p = 0.027). The hemophilia cohort also experienced a higher mortality rate (7.1% vs. 3.3%, p = 0.037) and longer hospital stays. CONCLUSION: Patients with hemophilia undergoing PCI are at a significantly greater risk of adverse events, increased mortality, and longer hospital stays than the general population. To mitigate the risk of unfavorable outcomes, it is crucial to ensure adequate replenishment of coagulation factors and establish close collaboration between cardiologists and hematologists.
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Achkar et al. (2024) conducted a cohort in Acute coronary syndrome. Hemophilia vs. Without hemophilia was evaluated on Mortality (p=0.037). Hemophilia in adults undergoing PCI for acute coronary syndrome was associated with higher mortality (7.1% vs. 3.3%, p=0.037) and gastrointestinal bleeding (11.0% vs. 2.8%, p<0.001).
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