Outcomes Following Percutaneous Coronary Intervention in Patients With Multivessel Disease Who Were Recommended for But Declined Coronary Artery Bypass Graft Surgery.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Wiley-Blackwell
    • Subject Terms:
      Percutaneous Coronary Intervention*/adverse effects ; Coronary Artery Bypass*/adverse effects ; Coronary Artery Disease*/surgery ; Coronary Artery Disease*/mortality; Humans ; Male ; Female ; Aged ; Middle Aged ; Treatment Outcome ; Retrospective Studies ; Risk Factors ; Risk Assessment ; Patient Selection ; Clinical Decision-Making
    • Abstract:
      Background: Patients may prefer percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery, despite heart team recommendations. The outcomes in such patients have not been examined. We sought to examine the results of PCI in patients who were recommended for but declined CABG.
      Methods and Results: Consecutive patients with stable ischemic heart disease and unprotected left main or 3-vessel disease or Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score >22 who underwent PCI after heart team review between 2013 and 2020 were included. Patients were categorized into 3 groups according to heart team recommendations on the basis of appropriate use criteria: (1) PCI-recommended; (2) CABG-eligible but refused CABG (CABG-refusal); and (3) CABG-ineligible. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. The study included 3687 patients undergoing PCI (PCI-recommended, n=1718 [46.6%]), CABG-refusal (n=1595 [43.3%]), and CABG-ineligible (n=374 [10.1%]). Clinical and procedural risk increased across the 3 groups, with the highest comorbidity burden in CABG-ineligible patients. Composite events within 1 year after PCI occurred in 55 (4.1%), 91 (7.0%), and 41 (14.8%) of patients in the PCI-recommended, CABG-refusal, and CABG-ineligible groups, respectively. After multivariable adjustment, the risk of the primary composite outcome was significantly higher in the CABG-refusal (hazard ratio [HR], 1.67 [95% CI, 1.08-3.56]; P =0.02) and CABG-ineligible patients (HR, 3.26 [95% CI, 1.28-3.65]; P =0.004) groups compared with the reference PCI-recommended group, driven by increased death and stroke.
      Conclusions: Cardiovascular event rates after PCI were significantly higher in patients with multivessel disease who declined or were ineligible for CABG. Our findings provide real-world data to inform shared decision-making discussions.
    • Comments:
      Comment in: J Am Heart Assoc. 2024 Jun 4;13(11):e035891. doi: 10.1161/JAHA.124.035891. (PMID: 38818930)
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    • Contributed Indexing:
      Keywords: coronary artery disease; coronary revascularization; multivessel coronary disease; patient preferences; shared decision‐making
    • Publication Date:
      Date Created: 20240531 Date Completed: 20240604 Latest Revision: 20240720
    • Publication Date:
      20240720
    • Accession Number:
      PMC11255644
    • Accession Number:
      10.1161/JAHA.123.033931
    • Accession Number:
      38818962