Outcomes and predictors of mortality in patients with acute leukemia undergoing percutaneous coronary intervention (PCI) : a 7-year U.S analysis

Background Patients with acute leukemia requiring percutaneous coronary intervention (PCI) represent a high-risk population at the intersection of oncologic and cardiovascular disease. This study aimed to determine in-hospital mortality rates, identify mortality predictors, and characterize complications in acute leukemia patients undergoing PCI. Methods Retrospective cohort analysis using the National Inpatient Sample (2016-2022) identified adult patients with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) who underwent PCI. Multivariable logistic regression identified independent mortality predictors after adjusting for demographics, comorbidities, leukemia subtype, and hospital factors. Primary outcome was in-hospital mortality; secondary outcomes included acute kidney injury, major bleeding, blood transfusion, and stroke. Results Among 285 admissions representing 1,425 patients nationwide (22.8% ALL, 77.2% AML; mean age 67 years), overall in-hospital mortality was 11.9% (95% CI: 8.7%-16.2%). Mortality differed by subtype: 4.6% in ALL versus 14.1% in AML (p=0.038). Advancing age was an independent mortality predictor (adjusted OR 1.055 per year, 95% CI: 1.008-1.104, p=0.022). AML versus ALL demonstrated a trend toward increased risk (adjusted OR 3.23, p=0.080). Acute kidney injury was the most prevalent complication at 87.7%. Non-survivors incurred significantly higher hospital charges ($222,639 vs. $147,959; p=0.013). Conclusions Acute leukemia patients undergoing PCI experience substantial in-hospital mortality of approximately 12%, with AML patients at significantly higher risk than ALL patients. Age is the primary independent mortality predictor. The exceptionally high acute kidney injury rate highlights the urgent need for nephroprotective strategies and intensive multidisciplinary cardio-oncology care.