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Background: Cardiac catheterization is the gold standard test for hemodynamic assessment of patients with pulmonary hypertension (PH). The risk of this procedure in children with PH is uncertain. PH registries report mortality risks of 0-0.06%, while an estimate of the risk of catastrophic adverse events <1 day from catheterization using administrative data from a broader range of pediatric hospitals was 3.5%. We sought to utilize a national clinical registry to measure the risk of catastrophic adverse outcome and identify risk factors for those events.
Methods: A multicenter retrospective cohort study was performed using data from the IMPACT® registry of subjects up to 21 years with PH undergoing catheterization from 1/2011 to 12/2015. Subjects were identified using a combination of diagnostic codes and hemodynamic parameters. Using multivariable logistic regression, the association between pre-specified covariates and the risk of a composite outcome (death within 1 day of catheterization, cardiac arrest, or initiation of mechanical circulatory support following cardiac catheterization) was assessed.
Results: 9,010 procedures performed in 6,669 subjects with PH at 74 centers were studied. Median age was 3 years (IQR: 0-11). The etiology of PH was primary pulmonary hypertension in 23%, congenital heart disease 53%, status post heart transplantation 16%, cardiomyopathy 6%, and pulmonary vein stenosis 6%. Median pulmonary vascular resistance was 4.1 WU m2 (IQR: 2.6-6.5). 2% had undergone a cardiac operation in the prior 30 days, 14% received mechanical ventilation, and 13% received inotropes. In terms of procedural risk, 49% of procedures were in the lowest risk IMPACT® risk category. The observed risk of composite outcome was 1.2%, and death before discharge was 4.7%. Younger age, lower systemic arterial oxygen saturation, and receipt of inotropic agents were associated with increased risk of adverse outcome.
Conclusions: The risk of catastrophic adverse outcome following cardiac catheterization in PH patients in IMPACT® was significantly higher than that reported from PH-specific registries. Further research is necessary to determine to degree to which this risk is modifiable.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:15 p.m.-1:25 p.m.
Session Title: Finding Out What Works in Pediatric and Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1312M-09
- 2017 American College of Cardiology Foundation