In-hospital clinical outcomes of percutaneous coronary intervention for patients deemed ineligible for surgical revascularization

Abstract

Background: Ineligibility for surgical revascularization remains subjective with limited data. Coronary artery bypass graft surgery (CABG)-ineligible patients usually have a high prevalence of risk factors and complex coronary disease, which lead to worse clinical outcomes. Aim(s): We aimed to evaluate CABG surgical ineligibility reasons and inhospital percutaneous coronary intervention (PCI) outcomes at a large tertiary centre. Method(s): Anonymized, prospectively collected data from the institutional electronic records between April 2013 and November 2020 were analysed retrospectively. All patients who were formally turned down for CABG and had PCI were included. Result(s): There were 473 patients in total. Perceived frailty of the patient with associated comorbidities and/or the quality of distal coronary arteries were the main documented reasons for surgical ineligibility in 52.4% of patients. Mean age was 72+/-11 years, mean body mass index was 29+/-6 kg/m2 and 69.8% were male. Stable angina constituted 216 patients (45.7%) and 257 patients (54.3%) had acute coronary syndromes. Mean hospital stay was 4+/-5 days. Procedural success was documented in 457 out of 473 patients (96.6%). PCI adjunctive tools included coronary imaging in 97 patients (20.5%), rotational atherectomy in 96 patients (20.3%), laser atherectomy in 12 patients (2.5%), lithotripsy in 3 patients (0.6%) and physiological assessments in 34 patients (7.2%). In-hospital major adverse cardiac events were experienced in 32 patients (6.8%), death in 12 patients (2.5%), myocardial infarction in 21 patients (4.4%), ischaemic stroke in 1 patient (0.2%), coronary perforation in 7 patients (1.5%), repeat target vessel revascularization in 6 patients (1.3%), major access-site bleeding in 2 patients (0.4%), aortic dissection in 1 patient (0.2%) and new acute kidney injury requiring dialysis in 1 patient (0.2%). Conclusion(s): PCI in surgically ineligible patients is generally safe and effective. The process of determining suitability for surgical revascularization remains complex in the real-world.