SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

Grines, Cindy L.; Box, Lyndon C.; Mamas, Mamas A.; Abbott, J. Dawn; Blankenship, James C.; Carr, Jeffrey G.; Curzen, Nick; Kent, William; Khatib, Yazan; Matteau, Alexis; Rymer, Jennifer; Schreiber, Theodore L.; Velagapudi, Poonam; Vidovich, Mladen I.; Waldo, Stephen W.; Seto, Arnold H.

doi:10.1016/j.jcin.2022.12.016

Cited by 9 publications

(6 citation statements)

References 48 publications

(65 reference statements)

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“…As such, it seems reasonable that a patient with decreased LVEF is a concern to operators in this survey, but less of a concern than a patient with a high‐risk lesion. This sentiment is mirrored in the 2023 SCAI Expert Consensus Statement which suggests that PCI at no‐SOS centers is acceptable as long as the center and operator are capable of MCS support, calcium modification tools, and have high PCI volume 2 …”

Section: Discussionmentioning

confidence: 99%

“…What was once considered a class III recommendation for elective PCI with no‐SOS in the 2005 ACC/AHA/SCAI PCI Guideline Update 1 is now considered reasonable for experienced operators. The most recent 2023 SCAI Expert Consensus Statement on PCI with no‐SOS is the least restrictive in terms of case selection and is backed by outcomes data from a number of United States and international studies that show comparable mortality and emergency surgery outcomes between no‐SOS centers and those with surgical backup 2–5 . This evolution of US guidelines has shifted closer to international norms where many PCIs are done at no‐SOS centers and even represent the majority as compared to the United States, where no‐SOS centers still perform the minority of PCI cases.…”

Section: Introductionmentioning

confidence: 99%

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Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

Fernandez,

Shroff,

Vidovich

2023

Cathet Cardio Intervent

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BackgroundPercutaneous coronary intervention (PCI) without surgical backup is becoming increasingly common in the United States. Additionally, a recent SCAI expert consensus document has liberalized recommendations for performing PCI without cardiac surgery on site (SOS).AimsThe current study sought to understand practice patterns and operator preferences with regard to performing PCI without SOS.MethodsTwo internet‐based surveys were distributed to interventional cardiologists worldwide. Survey items asked about operator demographics, procedural preferences when performing PCI without SOS, self‐judged personality traits, and history of malpractice.ResultsBetween March 2021 and May 2021, 517 interventional cardiologists completed the survey; 341 of whom perform elective PCI without SOS (no‐SOS operators), and 176 who perform elective PCI with surgical backup (SOS operators). Most operators were male 473 (91.5%). There was a greater proportion of SOS operators in academic practice (86 vs. 75, p < 0.001) and greater proportion of no‐SOS operators in hospital‐owned practices (158 vs. 56, p < 0.001). Lesion characteristics (left main, chronic total occlusions, and need for atherectomy) were the most important procedural attributes for no‐SOS operators, and international operators reported higher comfort levels with PCI on high‐risk lesions. Cumulative personality profile scores were similar between SOS and no‐SOS operators. SOS operators expressed more concern with legal ramifications of performing PCI without SOS (2.57 vs. 2.34, p = 0.049).ConclusionsIn the absence of surgical backup, lesion characteristics were the most important consideration for PCI patient selection for operators worldwide. Compared to the United States, international operators were more confident in performing high‐risk PCI without surgical backup.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

Fernandez,

Shroff,

Vidovich

2023

Cathet Cardio Intervent

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“…While CTO PCI may not be appropriate for every operator or every institution, therapy awareness and the option to undergo this intervention should be available to all eligible patients as part of a multidisciplinary Heart Team management model ( 30 , 62 – 64 ). Compared with complex non-CTO PCI, this intervention involves very unique techniques and equipment—to include specialized lesion crossing strategies, specialty wires and microcatheters, and re-entry devices ( 48 ).…”

Section: Is Cto Pci Appropriate For Every Operator and Every Center?mentioning

confidence: 99%

A non-interventional cardiologist’s guide to coronary chronic total occlusions

Cilia,

Megaly,

Davies

et al. 2024

Front. Cardiovasc. Med.

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Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.

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“…Patients with left main (LM) coronary artery stenosis are classified into two subgroups: protected (a previous patent coronary artery bypass surgery graft to one or more major branches of the left coronary) and unprotected LM (without such bypasses). Although coronary artery bypass grafting (CABG) is considered the gold standard of revascularization, technical improvements and stent technology made percutaneous coronary intervention (PCI) an increasingly utilized method of revascularization in patients with unprotected LM artery disease [ 1 , 2 , 3 ]. Complex PCI, including unprotected left main, is being performed at some centers where there is no on-site surgery, with no increase in major cardiovascular events or emergency CABG surgery compared with PCI at surgical centers, and a recent expert consensus statement supports the safety of PCI in this setting [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although coronary artery bypass grafting (CABG) is considered the gold standard of revascularization, technical improvements and stent technology made percutaneous coronary intervention (PCI) an increasingly utilized method of revascularization in patients with unprotected LM artery disease [ 1 , 2 , 3 ]. Complex PCI, including unprotected left main, is being performed at some centers where there is no on-site surgery, with no increase in major cardiovascular events or emergency CABG surgery compared with PCI at surgical centers, and a recent expert consensus statement supports the safety of PCI in this setting [ 1 ]. Patients with an obstruction of the LM may be at particularly high risk due to its anatomical features because LM provides 75–100% of the myocardium depending on coronary artery dominance [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Outcomes following Percutaneous Coronary Intervention in Unprotected Left Main Disease: A Single-Center Study

et al. 2023

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Background: Hemodynamically significant unprotected left main (LM) coronary artery disease is a high-risk clinical condition because of the large area of myocardium at risk, and it requires prompt revascularization. Percutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected LM disease in patients with low-to-intermediate anatomic complexity or when the patient refuses CABG after adequate counseling by the heart team. Methods: We retrospectively evaluated 201 patients receiving left main (LM) provisional one-stent or two-stent procedures, and we assessed the clinical characteristics and outcomes of patients undergoing unprotected LM PCI. Results: The mean age was 66.5 ± 9.9 years, and 72% were male. The majority of the subjects presented several cardiovascular risk factors, among which arterial hypertension (179 patients, 89.5%) and dyslipidemia (173 patients, 86.5%) were the most frequent. Out of all patients, 162 (81.8%) underwent revascularization by using the one-stent technique, while the two-stent technique was used in 36 patients (18.2%). The median value of fractional flow reserve (FFR) of the side branch was 0.9 [0.85–0.95], and 135 patients (67.1%) showed a value of FFR > 0.8. One hundred nine patients (54.2%) had a stent enhancement side branch length (SESBL) > 2, with median values of 2.5 mm2 [2.1–3]. Regarding angiographic parameters, the LM area as assessed by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and the grade of stenosis as assessed by quantitative coronary angiography (QCA) were similar between groups. However, patients who required revascularization by using the two-stent technique presented more frequently with intermediate rather than low SYNTAX scores (69.4% vs. 28.4%, p < 0.0001). Also, the same group required kissing balloon inflation (KBI) more frequently (69.4% vs. 30%, p < 0.001). There were no differences regarding the success of revascularization between the use of the one-stent or two-stent technique. FFR was able to predict a SESBL > 2 mm. The cut-off value for FFR to afford the highest degree of sensitivity (74.5%) and specificity (47%) for a SESBL > 2 was >0.86, indicating a moderate accuracy (AUC = 0.61, 95% CI 0.525–0.690, p = 0.036). Conclusions: Unprotected left main PCI is a safe and effective revascularization option amongst a complex and morbid population. There were no differences regarding the success of revascularization between the use of the one-stent or two-stent technique, and there was no significant impact of KBI on side branch FFR measurements but lower side branch FFR values were correlated with angiographic side branch compromise.

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SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

Cited by 9 publications

References 48 publications

Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

A non-interventional cardiologist’s guide to coronary chronic total occlusions

Clinical Characteristics and Outcomes following Percutaneous Coronary Intervention in Unprotected Left Main Disease: A Single-Center Study

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