Predictors of Catastrophic Adverse Outcomes in Children With Pulmonary Hypertension Undergoing Cardiac Catheterization: A Multi-Institutional Analysis From the Pediatric Health Information Systems Database

J Am Coll Cardiol. 2015 Sep 15;66(11):1261-1269. doi: 10.1016/j.jacc.2015.07.032.

Abstract

Background: Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period.

Objectives: The purpose of this study was to identify risk factors for catastrophic adverse outcomes in children with PH undergoing cardiac catheterization.

Methods: We studied children and young adults up to 21 years of age with PH undergoing 1 or more cardiac catheterization at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors.

Results: A total of 6,339 procedures performed on 4,401 patients with a diagnosis of PH from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The observed risk of composite outcome was 3.5%. In multivariate modeling, the adjusted risk of the composite outcome was 3.3%. Younger age at catheterization, cardiac operation in the same admission as the catheterization, pre-procedural systemic vasodilator infusion, and hemodialysis were independently associated with an increased risk of adverse outcomes. Pre-procedural use of pulmonary vasodilators was associated with reduced risk of composite outcome.

Conclusions: The risk of cardiac catheterization in children and young adults with PH is high relative to previously reported risk in other pediatric populations. The risk is influenced by patient-level factors. Further research is necessary to determine whether knowledge of these factors can be translated into practices that improve outcomes for children with PH.

Keywords: Pediatric Health Information Systems Database; extracorporeal membrane oxygenation; intervention; mortality; outcomes research; pediatric cardiology.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / mortality*
  • Catastrophic Illness / mortality
  • Child
  • Child, Preschool
  • Cohort Studies
  • Databases, Factual* / trends
  • Female
  • Health Information Systems* / trends
  • Hospital Mortality / trends
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / mortality*
  • Hypertension, Pulmonary / therapy*
  • Infant
  • Infant, Newborn
  • Male
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult