Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease

Abstract

Background: Few studies have evaluated the prevalence and clinical outcomes of ad hoc percutaneous coronary intervention (PCI), performing diagnostic coronary angiography and PCI in the same session, in stable coronary artery disease (CAD) patients. Methods and Results:From the CREDO-Kyoto PCI/CABG registry cohort-2, 6,943 patients were analyzed as having stable CAD and undergoing first PCI. Ad hoc PCI and non-ad hoc PCI were performed in 1,722 (24.8%) and 5,221 (75.1%) patients, respectively. The cumulative 5-year incidence and adjusted risk for all-cause death were not significantly different between the 2 groups (15% vs. 15%, P=0.53; hazard ratio: 1.15, 95% confidence interval: 0.98-1.35, P=0.08). Ad hoc PCI relative to non-ad hoc PCI was associated with neutral risk for myocardial infarction, any coronary revascularization, and bleeding, but was associated with a trend towards lower risk for stroke (hazard ratio: 0.78, 95% confidence interval: 0.60-1.02, P=0.06). Conclusions:Ad hoc PCI in stable CAD patients was associated with at least comparable 5-year clinical outcomes as with non-ad hoc PCI. Considering patients' preference and the cost-saving, the ad hoc PCI strategy might be a safe and attractive option for patients with stable CAD, although the prevalence of ad hoc PCI was low in the current study population.

Incidence, predictors, and outcomes of DAPT non-compliance in planned vs. ad hoc PCI in chronic coronary syndrome

“…Consistent with previous studies, DAPT non-compliance was higher in old age and was associated with higher rates of MACE following stent placement [9,11]. Two large registries have investigated non-adherence to DAPT.…”

Cost-Effectiveness of PCSK9 Inhibitor Plus Statin in Patients With Triple-Vessel Coronary Artery Disease in Japan

“…However, in the scenario analysis the time horizon was changed to 5, 10, 20, and 40 years. 20 The estimated stroke rate increased with increasing age. PCSK9 inhibitor therapy was 20% superior to standard therapy in CAD prevention, 25% superior to standard therapy in stroke prevention, and 5% superior to standard therapy for all-cause death.…”

JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease

“…Although ad hoc PCI is commonly performed in other countries (>75% in the USA and South Korea), 160,161 it is less common in Japan (≤30%). 162 It is also known that there are wide interhospital disparities in the implementation of ad hoc PCI, and ad hoc PCI is more commonly performed in centers performing smaller numbers of annual PCIs. 162 Ad hoc PCI may be a reasonable choice to reduce cost, shorten length of stay, and ameliorate the patient's burden by omitting invasive coronary angiography for diagnostic purpose only.…”

“…162 It is also known that there are wide interhospital disparities in the implementation of ad hoc PCI, and ad hoc PCI is more commonly performed in centers performing smaller numbers of annual PCIs. 162 Ad hoc PCI may be a reasonable choice to reduce cost, shorten length of stay, and ameliorate the patient's burden by omitting invasive coronary angiography for diagnostic purpose only. However, in order to avoid PCI for inappropriate indications, the following conditions are mandatory.…”