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

Sukul, Devraj; Seth, Milan; Dixon, Simon; Zainea, Mark; Slocum, Nicklaus K.; Pielsticker, Elizabeth; Gurm, Hitinder S.

doi:10.1002/ccd.26781

Cited by 10 publications

(12 citation statements)

References 36 publications

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“…Some patients with an indication for CABG are deemed inoperable and subsequently referred for PCI. While registry data have shown that PCI of surgically ineligible patients is generally safe, the clinical characteristics and outcomes of these patients have not been well described 5 . The goal of this single‐center study is to describe the characteristics that contributed to ineligibility and determine the early and one‐year outcomes of this patient population.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention

Shields

Ouellette

Kiefer

et al. 2021

Cathet Cardio Intervent

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Objectives In this study we evaluated the clinical characteristics and outcomes of surgically ineligible patients with coronary artery disease (CAD) who underwent multivessel percutaneous coronary intervention (PCI). Background Patients with multivessel CAD who are surgically ineligible and undergo PCI are not well represented in large trials. Methods Out of 1,061 consecutive patients who underwent a non‐emergent PCI for unprotected left main or multivessel CAD at the University of Virginia Medical Center, 137 patients were determined to be surgically ineligible for coronary artery bypass graft (CABG) surgery by a heart team. The clinical characteristics and reasons for surgical ineligibility were collected. The coronary angiograms were reviewed and the SYNTAX score calculated. The Society of Thoracic Surgeons (STS) score was calculated. Outcomes were determined at 30 days and 1‐year. Results The mean age of the cohort was 71 and 59% were women. Hypertension, hyperlipidemia, tobacco abuse, and diabetes were common comorbidities. The average SYNTAX score was 22. The most commonly cited reasons for surgical ineligibility were advanced age, frailty, severe lung disease, ejection fraction ≤ 30% and STS score ≥ 8%. Outcomes at 30 days were excellent and better than those predicted by STS for surgery. Frailty and STS score predicted one‐year outcomes. Conclusions Patients undergoing PCI for multivessel disease who are surgically ineligible have multiple risk factors and comorbidities. Frailty, lung disease, poor left ventricular function, and high STS score represent common reasons for surgical ineligibility. Frailty and the STS score better predict one‐year outcomes after PCI compared to the SYNTAX score.

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Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention

Shields

Ouellette

Kiefer

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Indeed, it has been shown that registries are usually not well designed to characterize surgically ineligible patients and often do not capture the reason for ineligibility [12–14]. McNulty et al addressed the limitations of registries for adequate documentations of surgical candidacy and selection biases in nonemergent LMCA stenting.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several studies have shown that surgical ineligibility is associated with increased mortality in patients undergoing PCI on a diseased unprotected left main coronary artery (ULMCA) [12, 13]. More recently Sukul et al demonstrated in a larger study no difference in outcomes between surgically ineligible patients and the rest of the patients who underwent PCI, except in the subgroup of patients who underwent PCI on ULMCA [14]. In these patients, surgical ineligibility was associated with significantly higher and unacceptable in-hospital mortality as high as 20%.…”

Section: Introductionmentioning

confidence: 99%

Nonemergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported with Impella® Heart Pump in Patients Ineligible for Surgical Revascularization

Meraj

Dixon

Moses

et al. 2019

Journal of Interventional Cardiology

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Objectives. We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella® heart pump support. Background. ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. Methods. Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) rates as well as 30-day survival and MACCE rates between CABG ineligible and CABG eligible patients. Results. A total of 331 patients were included (293 Impella 2.5®, 38 Impella CP®); 227 were ineligible for CABG and 104 were eligible. Baseline characteristics were remarkable for a trend toward higher rate of chronic obstructive pulmonary disease in the ineligible patients. In-hospital mortality (3.52% vs. 5.77%; p=0.383) and MACCE (6.61% vs. 7.69%; p=0.816) rates as well as 30-day survival (92.0% vs. 93.4%; Log-Rank p-value =0.781) and MACCE (88.1% vs. 90.1%; Log-Rank p-value=0.648) rates were not different between the two groups. Conclusions. The results of our study suggest that prophylactic Impella support appears to mitigate the risks inherent to surgical ineligibility in patients undergoing a nonemergent ULMCA PCI. Our results require further investigation.

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“…Indeed, it has been shown that registries are usually not well designed to characterize surgically ineligible patients and often do not capture the reason for ineligibility [12][13][14]. McNulty et al addressed the limitations of registries for adequate documentations of surgical candidacy and selection biases in nonemergent LMCA stenting.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several studies have shown that surgical ineligibility is associated with increased mortality in patients undergoing PCI on a diseased unprotected left main coronary artery (ULMCA) [12,13]. More recently Sukul et al demonstrated in a larger study no difference in outcomes between surgically ineligible patients and the rest of the patients who underwent PCI, except in the subgroup of patients who underwent PCI on ULMCA [14]. In these patients, surgical ineligibility was associated with significantly higher and unacceptable inhospital mortality as high as 20%.…”

Section: Journal Of Interventional Cardiologymentioning

confidence: 99%

Non-Emergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported With Impella® Heart Pump in Patients Ineligible for Surgical Revascularization

Meraj

Hill

Dixon

et al. 2018

Journal of the American College of Cardiology

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Objectives. We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella5 heart pump support. Background. ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. Methods. Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) rates as well as 30-day survival and MACCE rates between CABG ineligible and CABG eligible patients. Results. A total of 331 patients were included (293 Impella 2.55, 38 Impella CP5); 227 were ineligible for CABG and 104 were eligible. Baseline characteristics were remarkable for a trend toward higher rate of chronic obstructive pulmonary disease in the ineligible patients. In-hospital mortality (3.52% vs. 5.77%; p=0.383) and MACCE (6.61% vs. 7.69%; p=0.816) rates as well as 30-day survival (92.0% vs. 93.4%; Log-Rank p-value =0.781) and MACCE (88.1% vs. 90.1%; rates were not different between the two groups. Conclusions. The results of our study suggest that prophylactic Impella support appears to mitigate the risks inherent to surgical ineligibility in patients undergoing a nonemergent ULMCA PCI. Our results require further investigation.

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

Abstract: PCI in a broad population of surgically ineligible patients is generally safe. However, among patients who underwent unprotected left main PCI, those deemed surgically ineligible experienced significantly worse outcomes as compared to the rest. © 2016 Wiley Periodicals, Inc.

Cited by 10 publications

References 36 publications

Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention

Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention

Nonemergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported with Impella® Heart Pump in Patients Ineligible for Surgical Revascularization

Non-Emergent Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Supported With Impella® Heart Pump in Patients Ineligible for Surgical Revascularization

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