Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Treatment decisions for multivessel coronary artery disease (CAD) often rely on subtle clinical factors not always captured in registries.
• Percutaneous coronary intervention (PCI) is an alternative to coronary artery bypass graft (CABG) surgery.

Purpose of the Study:

• To investigate the association between documented surgical ineligibility and long-term mortality in patients with unprotected left main or multivessel CAD undergoing PCI.

Main Methods:

• Retrospective analysis of 1013 patients undergoing non-emergent PCI for unprotected left main or multivessel CAD (2009-2012).
• Electronic medical records were reviewed to identify documentation of surgical ineligibility.
• Cox proportional hazard models adjusted for known mortality risk factors were used to assess outcomes.

Main Results:

• 22% of patients were documented as ineligible for CABG surgery.
• Common reasons for ineligibility included poor surgical targets, advanced age, and renal insufficiency.
• Documented surgical ineligibility was independently associated with increased in-hospital (OR 6.26) and long-term mortality (HR 2.98) after PCI.

Conclusions:

• Documented surgical ineligibility is prevalent in patients undergoing PCI for complex CAD.
• Surgical ineligibility is a significant independent predictor of adverse outcomes, including increased long-term mortality, following PCI.