Related Experiment Video
Updated: Apr 21, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease
Stephen W Waldo1, Eric A Secemsky1, Cashel O'Brien1
1From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston; Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.); Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.).
Insights
Surgical ineligibility in patients undergoing percutaneous coronary intervention for complex coronary artery disease is common. Documented ineligibility independently predicts higher in-hospital and long-term mortality risk.
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.
Background:
Decisions to proceed with surgical versus percutaneous revascularization for multivessel coronary artery disease are often based on subtle clinical information that may not be captured in contemporary registries. The present study sought to evaluate the association between surgical ineligibility documented in the medical record and long-term mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention.
Methods And Results:
All subjects undergoing nonemergent percutaneous coronary intervention for unprotected left main or multivessel coronary artery disease were identified at 2 academic medical centers from 2009 to 2012. Documentation of surgical ineligibility was assessed through review of electronic medical records. Cox proportional hazard models adjusted for known mortality risk factors were created to assess long-term mortality in patients with and without documentation of surgical ineligibility. Among 1013 subjects with multivessel coronary artery disease, 218 (22%) were deemed ineligible for coronary artery bypass graft surgery. The most common explicitly cited reasons for surgical ineligibility in the medical record were poor surgical targets (24%), advanced age (16%), and renal insufficiency (16%). After adjustment for known risk factors, documentation of surgical ineligibility remained independently associated with an increased risk of in-hospital (odds ratio, 6.26; 95% confidence interval, 2.16-18.15; P<0.001) and long-term mortality (hazard ratio, 2.98; 95% confidence interval, 1.88-4.72, P<0.001) after percutaneous coronary intervention.
Conclusions:
Documented surgical ineligibility is common and associated with significantly increased long-term mortality among patients undergoing percutaneous coronary intervention with unprotected left main or multivessel coronary disease, even after adjustment for known risk factors for adverse events during percutaneous revascularization.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:24Cardiac Catheterization III: Left Heart Catheterization