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Outcomes following percutaneous coronary intervention in patients previously considered "without option": a subgroup
Harray C Lowe1, Stephen N Oesterle, K L He
1Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Percutaneous coronary intervention (PCI) offered minimal symptom relief for "no-option" patients with advanced coronary artery disease. This study found only modest, non-significant improvements in exercise duration and angina status after PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Patients with advanced symptomatic coronary artery disease (CAD) often have limited treatment options.
- These
- no-option
- patients are typically not candidates for traditional revascularization like coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
Purpose of the Study:
- To assess the clinical outcomes of
- no-option
- patients who underwent PCI after being considered unsuitable for the procedure.
- To evaluate the therapeutic benefit of PCI in this challenging patient group.
Main Methods:
- Retrospective analysis of data from the Potential Angina Class Improvement From Intramyocardial Channels (PACIFIC) trial.
- Included patients originally randomized to percutaneous transmyocardial revascularization (PTMR) or medical therapy who subsequently underwent PCI within 12 months.
Main Results:
- Ten patients from the PTMR group and 11 from the medical group underwent PCI.
- Most patients had prior PCI and CABG, with a high prevalence of cardiovascular risk factors.
- PCI showed modest, non-significant improvements in exercise duration and angina status, with no quality of life improvement.
Conclusions:
- Percutaneous coronary intervention (PCI) provides only marginal symptomatic benefit for
- no-option
- patients with advanced coronary artery disease.
- Further research is needed to identify effective treatments for this population.
Objectives:
The present study assesses clinical outcomes in patients from the Potential Angina Class Improvement From Intramyocardial Channels (PACIFIC) trial of percutaneous transmyocardial revascularization (PTMR) who had previously been considered "no-option," but who subsequently underwent percutaneous coronary intervention (PCI) for continuing symptoms.
Background:
Patients with advanced symptomatic coronary artery disease who are not candidates for coronary artery bypass grafting (CABG) or PCI comprise an important group, for which no established treatment is currently available. These patients have been described as having "no option," and are currently targeted for various experimental therapies. One such proposed therapy, PTMR, was recently examined in the PACIFIC trial. A subgroup of patients in this trial subsequently underwent PCI, although to initially qualify for the study they had previously been considered as unsuitable for PCI and as having "no option." The therapeutic benefit of PCI for patients of this type is unknown.
Methods:
A retrospective analysis was performed on data obtained from all subjects of the PACIFIC study who underwent PCI within the 12-month follow-up period.
Results:
Ten subjects originally randomized to PTMR and 11 subjects from the medical treatment group underwent PCI. Most had undergone at least one prior PCI and at least one CABG, and there was a high prevalence of cardiovascular risk factors. Despite excellent immediate procedural success, PCI resulted in only modest, statistically nonsignificant increases in mean exercise duration, small improvements in angina status, and no significant improvements in quality of life.
Conclusions:
These data suggest that PCI provides only marginal-if any-symptomatic benefit in these patients.
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