Outcomes of percutaneous coronary intervention in patients with multiple myeloma: A national inpatient analysis Free

Background: Multiple myeloma (MM) is a plasma cell malignancy associated with a high burden of comorbidities, including chronic kidney disease and anemia. As treatment advances improve survival, patients with MM increasingly experience age-related conditions such as coronary artery disease. Limited data exist on the outcomes of percutaneous coronary intervention (PCI) in this unique population. This study compares inpatient outcomes of PCI in patients with and without a history of MM using a nationally representative database.

Methods: We conducted a retrospective analysis of adult hospitalizations from the National Inpatient Sample (NIS) between 2016 and 2020. Patients who underwent PCI were identified using ICD-10-PCS codes and stratified based on the presence or absence of a diagnosis of MM. National estimates were calculated using discharge weights. Multivariable logistic and linear regression models were used to evaluate in-hospital outcomes, adjusted for demographics, hospital characteristics, and comorbidities including the Charlson Comorbidity Index. Outcomes included mortality, acute kidney injury (AKI), cardiogenic shock, respiratory failure, cerebral infarction, packed red blood cell (PRBC) transfusion, and a composite of major bleeding. Secondary outcomes included length of stay (LOS) and total hospital charges. Statistical significance was set at p < 0.05.

Results: A total of 487,235 weighted PCI hospitalizations were identified, of which 930 (0.19%) involved patients with a history of multiple myeloma. Among patients undergoing PCI, those with MM did not have significantly different in-hospital mortality compared to those without MM (adjusted odds ratio [aOR] 0.91, 95% CI: 0.51–1.60; p = 0.733). AKI was significantly less common in MM patients (aOR 0.60, p = 0.005). Cardiogenic shock occurred less frequently in MM patients (aOR 0.63, p = 0.099), though not statistically significant. No significant differences were observed in rates of respiratory failure (aOR 0.89, p = 0.528) or cerebral infarction (aOR 0.44, p = 0.161). In contrast, MM patients were significantly more likely to require PRBC transfusion (aOR 2.02, p = 0.002) and experienced a higher risk of major bleeding (aOR 1.97, p = 0.002). Mean LOS was comparable between groups (5.6 days in MM vs. 5.7 days in non-MM, adjusted difference –0.14 days; p = 0.797). Total hospital charges were also similar ($65,200 vs. $66,300; adjusted difference –$6,500, p = 0.239).Conclusion: Patients with multiple myeloma undergoing PCI experience similar inpatient mortality, length of stay, and hospital charges compared to those without MM. However, they are at significantly higher risk for bleeding and transfusion, underscoring the need for proactive hematologic assessment and bleeding risk mitigation in this population. Interestingly, AKI appeared to be less frequently coded in MM patients, which may reflect under-recognition or diagnostic overshadowing in the context of baseline renal dysfunction. These findings highlight the importance of tailored cardiovascular care in patients with MM undergoing invasive procedures.