Percutaneous Coronary Intervention Outcomes Based on Decision-Making Capacity

• Published in: Journal of the American Heart Association Vol. 10; no. 17; p. e020609
• Main Authors: Singh, Jarmanjeet, Kassis, Nicholas, Ahuja, Keerat R, Sheth, Chirag, Verma, Beni R, Saxena, Saket, Krishnaswamy, Amar, Ellis, Stephen, Khatri, Jaikirshan, Menon, Venu, Kapadia, Samir R
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 07.09.2021; Wiley
• Subjects: coronary angioplasty outcomes; Coronary Artery Bypass; Coronary Artery Disease - surgery; Decision Making; Humans; Informed Consent; Kaplan-Meier Estimate; major adverse cardiac events; Original Research; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Retrospective Studies; Risk Factors; surrogate consent; Third-Party Consent; Treatment Outcome; major adverse cardiac events; percutaneous coronary intervention; coronary angioplasty outcomes; informed consent; surrogate consent
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.020609

Background Long-term outcomes of percutaneous coronary intervention (PCI) based on patients' decision-making ability have not been studied. Our objective was to assess long-term outcomes after PCI in patients who provided individual versus surrogate consent. Methods and Results Data were collected retrospectively for patients who underwent PCI at Cleveland Clinic between January 1, 2015 and December 31, 2016. Inclusion criteria consisted of hospitalized patients aged ≥20 years who had PCI. Patients with outpatient PCI, or major surgery 30 days before or 90 days after PCI, were excluded. Patients who underwent PCI with surrogate consent versus individual consent were matched using the propensity analysis. Kaplan-Meier, log rank, -statistic, and χ tests were used for statistical analysis. The study was approved by the Institutional Review Board at Cleveland Clinic, Ohio. Of 3136 patients who underwent PCI during the study period, 183 had surrogate consent. Propensity matching yielded 149 patients from each group. Two-year all-cause mortality was significantly higher in the surrogate consent group (38 [25.5%] versus 16 [10.7%] deaths, log-rank =10.16, <0.001). The 2-year major adverse cardiac events rate was also significantly higher in the surrogate consent group (60 versus 36 events, log-rank =8.36, =0.003). Conclusions Patients with surrogate consent had significantly higher all-cause mortality and higher major adverse cardiac events when compared with patients with individual consent. This study emphasizes the fact that patients with an inability to give consent are at high risk and may need special attention in postprocedural and postdischarge care.