title: Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study).
abstract: Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors.
authors.affiliation: Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, University of Keele, United Kingdom; Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Farzin
authors.initials: F
authors.lastname: Fath-Ordoubadi
authors.affiliation: Division of Cardiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Gian B
authors.initials: GB
authors.lastname: Danzi
authors.affiliation: SBD Analytics, Hertstraat, Bekkevoort, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Spaepen
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, University of Keele, United Kingdom; Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, University of Keele, United Kingdom; Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
authors.affiliation: Cardiology Department, The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Cardiology Department, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: European Medical and Clinical Division, Terumo Europe, Leuven, Belgium.
authors.forename: Dragica
authors.initials: D
authors.lastname: Paunovic
authors.affiliation: Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
mesh_terms: D000368:Aged; D001208:Asia / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015897:Comorbidity / Q000639:trends; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery; D054855:Drug-Eluting Stents; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors