This article is more than 5 years old. Information may no longer be current.
PCI generally safe for surgically ineligible patients
Among patients considered ineligible for surgical revascularization, PCI appears to be a generally safe option, but unprotected left main PCI yields significantly worse outcomes in this population, according to recent findings.
In the retrospective study, researchers evaluated 99,370 patients enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, a prospective registry of all patients undergoing PCI in all nonfederal hospitals in Michigan. The present study identified consecutive patients who underwent PCI between 2010 and 2014.
The researchers defined surgical ineligibility as written evidence of an evaluation by a cardiac surgeon, who concluded that the patient was not a suitable candidate for surgery for any reason. Patients were stratified into two groups: those turned down for surgical revascularization and the remainder of patients, who may or may not have undergone assessment by a cardiac surgeon.
omes included the onset of postprocedural cardiogenic shock, cerebrovascular accident, contrast-induced nephropathy and new requirement for dialysis.
The researchers found that, of the 99,370 patients in the overall cohort, 1,922 (1.9%) were deemed ineligible for surgery. Surgically ineligible patients and the remainder of patients had generally comparable baseline characteristics, although ineligible patients had a higher prevalence of prior MI and prior PCI.
No significant variations were observed at the site level in the incidence of surgical ineligibility across the 33 hospitals with onsite surgical backup (range, 1.5%-2.5%). The two patient groups had the same rate of in-hospital mortality (0.52%). This finding persisted after adjustment for preprocedural predicted risk for mortality, PCI-treated CAD anatomy and hospital-level clustering in a hierarchical regression model (adjusted OR = 1.11; 95% CI, 0.57-2.15). Moreover, no significant differences were observed in terms of cardiogenic shock (ineligible patients, 0.68%; others, 0.73%), cerebrovascular accident (ineligible patients, 0.05%; others, 0.19%), new requirement for dialysis (ineligible patients, 0.16%; others, 0.19%) and contrast-induced nephropathy (ineligible patients, 2.68%; others, 2.25%).
= 1,074), those turned down for surgical revascularization (n = 20) had higher rates of in-hospital mortality (20% vs. 5.3%; P = .022), cardiogenic shock (25% vs. 5.1%; P = .0004) and new requirement for dialysis (10.5% vs. 1.6%; P = .042) vs. the remainder of patients (n = 1,054), according to the researchers. Four of the 10 in-hospital deaths in surgically ineligible patients occurred in those who underwent left main PCI.
“PCI in a broad population of surgically ineligible patients appears safe, potentially highlighting the discretion utilized by interventional cardiologists in selecting these patients,” the researchers wrote. “Importantly though, there is a substantial effect of surgical ineligibility on mortality in the subgroup of patients who underwent unprotected left main PCI, although this finding should be interpreted with caution as only 20 surgically ineligible patients underwent left main PCI.” – by Jennifer Byrne
Disclosure: One researcher reports receiving research funding from Blue Cross Blue Shield of Michigan and the NIH, and consulting for Osprey Medical.