Poor outcomes in CCE patients point to need for better risk-stratification before PCI

Patients with cholesterol crystal embolism (CCE) endure poor prognoses, highlighting the need for better identification of high-risk patients before undergoing percutaneous coronary intervention (PCI), a recent study has found.

Researchers looked at 23,184 patients who had undergone PCI from January 2000 to December 2019. CCE was diagnosed histologically or through a combination of cutaneous signs and blood test results. Study endpoints included the prognosis and associated risk factors in patients with CCE.

Over the 20-year study period, only 88 patients were diagnosed with CCE, yielding an incidence rate of 0.38 percent. Of these, 33 (37.5 percent) had definite CCE while 55 (62.5 percent) had probable CCE. Patients with CCE tended to be older and were more likely to have aortic aneurysms and chronic kidney disease than non-CCE counterparts.

Multiple logistic regression analysis confirmed that age ≥70 years was a significant risk factor for CCE (odds ratio [OR], 1.89, 95 percent confidence interval [CI], 1.18–3.01; p=0.008) as was abdominal aortic aneurysms (OR, 3.27, 95 percent CI, 1.91–5.60; p<0.001). Chronic kidney disease did not have such an effect (OR, 1.59, 95 percent CI, 0.90–2.83; p=0.113).

Meanwhile, smoking (OR, 1.68, 95 percent CI, 1.04–2.70; p=0.033) and femoral access (OR, 2.43, 95 percent CI, 1.41–4.18; p=0.001) were both more common in CCE patients. The use of an inner sheath, in contrast, was significantly protective (OR, 0.46, 95 percent CI, 0.30–0.72; p<0.001).

In terms of outcomes, the 88 CCE patients were followed for a mean of 2,316 days. The resulting 30-day, 1-year, and 5-year mortality rates were 3.4 percent, 10 percent, and 28 percent, respectively. Nine patients needed chronic haemodialysis within 1 year after PCI.