Clinical outcomes of percutaneous coronary intervention in high‐risk patients turned down for surgical revascularization

Abstract

Aims There are limited data on outcomes of PCI in surgical turndown patientsespecially in those presenting with ACS. Methods and Results A retrospective analysis of prospectively collected data of patients who were turned down for CABG and had PCI between 2013 and 2020. All consecutive patients (449), ACS (n = 245) and no‐ACS (n = 204) were included. In‐hospital complications occurred in 28 patients (6.2%). At 30 days, 27 patients (6.0%) died (18 patients in the ACS group [7.3%] vs. 9 patients in the no‐ACS group [4.4%], p = 0.23). Following multivariate analysis, no significant difference in long‐term mortality was observed between the two groups (median follow‐up of 4 [2–6] years, hazard ratio [HR]: 1.08, 95% confidence interval [CI]: 0.75–1.58, p = 0.667). In propensity score‐matched analysis, the adjusted mortality risk was also not different between the groups (HR: 0.74, 95% CI: 0.25–1.26, p = 0.374). Independent predictors of mortality included chronic kidney disease stage ≥ 3 (HR: 1.64, 95% CI: 1.13–2.39, p = 0.009), high European System for Cardiac Operative Risk Evaluation II (HR: 1.02, 95% CI: 1.00–1.05, p = 0.035), and laser atherectomy use (HR: 3.35, 95% CI: 1.32–8.54, p = 0.011). Conclusions PCI in surgical patients turndown patients appears safe. ACSpresentation was associated with more comorbid illnesses; however, afteradjustment, ACS did not independently confer additional risk of mortality.

Percutaneous coronary intervention versus coronary artery bypass grafting in complex coronary artery disease: Long-term clinical outcomes from a high-volume center

“…Fourth, approximately a quarter of the PCI cohort was ineligible for CABG surgery due to factors not necessarily captured by clinical risk scores, such as frailty, poor distal coronary target, and/or morbid obesity. [ 29 ] These factors were not possible to adjust for in the analysis and likely contributed to the observed numerical increase in clinical events after PCI compared to CABG. Fifth, we did not have data on the stroke endpoint.…”

Turndown for coronary artery bypass surgery: Never say never to revascularization

“…In this issue of Catheterization and Cardiovascular Interventions, Farag et. al reported their experience comparing patients with acute coronary syndrome (ACS) versus stable angina patients who were turned down for bypass surgery and subsequently treated with coronary stenting 1 . We congratulate the authors on compiling data on this large cohort of 449 patients.…”

“…al reported their experience comparing patients with acute coronary syndrome (ACS) versus stable angina patients who were turned down for bypass surgery and subsequently treated with coronary stenting. 1 We congratulate the authors on compiling data on this large cohort of 449 patients. We agree with their comment that determination of surgical eligibility is inherently subjective, and in fact, despite "formal heart team evaluation," the reasons for surgical turn down were documented in only half of the patients.…”