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Updated: Aug 9, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery
Adam C Salisbury1, J Aaron Grantham1, W Morris Brown2
1Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA.
Insights
Patients ineligible for coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI) have complex conditions. PCI leads to improved health status and mortality rates lower than surgeon estimates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes
Background:
- Percutaneous coronary intervention (PCI) is increasingly utilized for patients unsuitable for coronary artery bypass grafting (CABG).
- Limited data exists on the characteristics and outcomes of this specific patient cohort.
- Complex coronary artery disease (CAD) necessitates alternative revascularization strategies.
Purpose of the Study:
- To characterize patients with left main or multivessel CAD who are ineligible for CABG.
- To evaluate the accuracy of risk prediction models in this population.
- To assess the clinical outcomes and health status following PCI.
Main Methods:
- Prospective registry of patients undergoing medical therapy + PCI for complex CAD.
- Independent core laboratory analysis of angiograms.
- Calculation of observed-to-expected 30-day mortality ratios using STS, EuroSCORE II, surgeon estimates, and NCDR CathPCI models.
- Assessment of patient health status at baseline, 1 month, and 6 months.
Main Results:
- 726 patients were enrolled with a mean SYNTAX score of 32.4 ± 12.2 (pre-PCI).
- All-cause mortality was 5.6% at 30 days and 12.3% at 6 months.
- Observed-to-expected mortality ratios varied significantly by risk model: STS (1.06), EuroSCORE II (0.99), surgeon estimates (0.59), and NCDR CathPCI (4.46).
- Significant improvements in SAQ and Kansas City Cardiomyopathy Questionnaire scores were observed by 6 months.
Conclusions:
- Patients ineligible for CABG undergoing PCI present with complex clinical profiles and high disease burden.
- Post-PCI mortality is lower than surgeon estimates and similar to surgical risk models, but significantly higher than NCDR CathPCI predictions.
- PCI improves patients' health status significantly up to 6 months post-procedure.
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 ± 12.2 before and 15.0 ± 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 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 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.
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