Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery.

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.