Association of liver dysfunction with outcomes after percutaneous coronary intervention - a systematic review and meta-analysis

Abstract

Background: Liver dysfunction is a known risk factor in the cardiovascular field. It specifically increases perioperative risk in patients undergoing coronary bypass surgery. Since percutaneous coronary intervention (PCI) is the much less invasive procedure for the treatment of coronary artery disease, we aimed to assess the relationship of liver dysfunction with outcomes in patients undergoing PCI.

Methods: Three libraries were searched (MEDLINE, Web of Science and The Cochrane Library). We performed a meta-analysis of all studies in patients who underwent PCI that provided information on the presence or absence of liver dysfunction. Primary outcome was short-term mortality. Secondary outcomes were major adverse cardio- and cerebrovascular events (MACCE), bleeding and acute kidney injury. Random-effects model was applied.

Results: Five studies were selected and the data from 10,710,317 patients were included in the final analysis. In comparison with the absence of liver dysfunction, patients with liver dysfunction were associated with higher short-term mortality (OR 2.97, 95%CI 1.23-7.18, p = 0.02), higher MACCE (OR 1.42, 95%CI 1.08-1.87, p = 0.01), and higher bleeding (OR 2.23, 95%CI 1.65-3.00, p < 0.01). There was no significant difference regarding acute kidney injury (OR 1.20, 95%CI 0.50-2.87, p = 0.69).

Conclusions: The analysis suggests that liver dysfunction in patients undergoing PCI is independently associated with higher risk of short-term mortality and increased occurrence of MACCE and bleeding. However, there appears to be no association to acute kidney injury.

Keywords: Coronary artery disease; Liver dysfunction; Percutaneous coronary intervention.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram

Fig. 2

(Central Picture). Graphical abstract showing the main findings of the analysis. MACCE = major adverse cardio- and cerebrovascular event

Fig. 3

Forest plot for short-term mortality. CI = confidence interval, OR = odds ratio

Fig. 4

Forest plot for major adverse cardiovascular events. CI = confidence interval, OR = odds ratio

Fig. 5

Forest plot for bleeding. CI = confidence interval, OR = odds ratio

Fig. 6

Forest plot for acute kidney failure. CI = confidence interval, OR = odds ratio