Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery

BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes. OBJECTIVES This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG).METHODS Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months. RESULTS A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 & PLUSMN; 12.2 before and 15.0 & PLUSMN; 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons' estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 & PLUSMN; 22.5 vs 86.5 & PLUSMN; 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 & PLUSMN; 27.2 vs 82.6 & PLUSMN; 19.7; P < 0.0001).CONCLUSIONS Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons' estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients' health status improved significantly through 6 months. (J Am Coll Cardiol Intv 2023;16:261-273) & COPY; 2023 by the American College of Cardiology Foundation.

Automated summary

This study describes the characteristics, risk prediction utility, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG) who underwent percutaneous coronary intervention (PCI). The short-term mortality rate after PCI was lower than estimated by surgeons but higher than predicted by the NCDR CathPCI model. Patients' health status significantly improved at 6 months.