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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.

We aimed to evaluate the reasons for surgical ineligibility and in-hospital outcome of percutaneous coronary intervention (PCI) in these patients at a large tertiary centre.