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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
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Surgical Ineligibility and Long-Term Outcomes in Patients With Severe Coronary Artery Disease

Yukiko Matsumura-Nakano1, Hiroki Shiomi1, Takeshi Morimoto2

  • 1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|August 23, 2019
PubMed

Insights

Patients with severe coronary artery disease (CAD) ineligible for surgery who underwent percutaneous coronary intervention (PCI) had significantly worse long-term outcomes. These outcomes were worse compared to those who received PCI without surgical ineligibility and those who underwent coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Severe coronary artery disease (CAD) often necessitates coronary revascularization.
  • The prevalence and impact of surgical ineligibility in CAD patients undergoing revascularization are not well-defined.

Purpose of the Study:

  • To investigate the prevalence of surgical ineligibility in patients with severe CAD undergoing revascularization.
  • To evaluate the clinical effect of surgical ineligibility on long-term outcomes.

Main Methods:

  • Analysis of 3,982 patients with triple-vessel or left main disease from the CREDO-Kyoto PCI/CABG registry cohort-2.
  • Comparison of outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) groups.
  • Assessment of surgical ineligibility documented in hospital charts, primarily due to comorbidities and advanced age.

Main Results:

  • Surgical ineligibility was present in 6.5% of PCI patients.
  • Five-year cumulative incidence of death/myocardial infarction/stroke was 52.5% for PCI patients with surgical ineligibility, versus 27.6% for PCI patients without, and 24.0% for CABG patients (P<0.001).
  • Adjusted analysis showed significantly higher risks for PCI patients with surgical ineligibility (HR 1.97) and without (HR 1.37) compared to CABG patients.

Conclusions:

  • Percutaneous coronary intervention (PCI) patients with surgical ineligibility experience worse long-term outcomes in severe coronary artery disease (CAD).
  • Outcomes for PCI patients with surgical ineligibility were poorer than for PCI patients without and for coronary artery bypass grafting (CABG) patients.
Abstract

Keywords:
Coronary artery bypass graftingCoronary artery diseasePercutaneous coronary interventionSurgical ineligibility

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