Ad Hoc Percutaneous Coronary Intervention in Stable Patients With Multivessel or Unprotected Left Main Disease

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Health Services Research

Background:

• Limited data exists on ad hoc percutaneous coronary intervention (PCI) use in stable multivessel (MV) or unprotected left main (LM) disease.
• A heart team approach is recommended for these complex patient groups.

Purpose of the Study:

• To determine the utilization rates of ad hoc PCI in patients with MV or LM disease.
• To investigate inter-hospital variations in ad hoc PCI practices for these patient populations.

Main Methods:

• Utilized New York State cardiac registries data from 2018-2019.
• Analyzed ad hoc PCI as a percentage of all PCI and revascularizations for MV/LM disease.

Main Results:

• Ad hoc PCI was performed in 78.4% of eligible patients, with rates varying by disease complexity (58.7% for unprotected LM to 85.4% for 2-vessel proximal LAD disease).
• Ad hoc PCIs represented 35.1% of all revascularizations, showing significant hospital-level variation (15% to 46% for 3-vessel disease).
• Utilization was higher in hospitals without on-site surgery and in specific patient subgroups.

Conclusions:

• Ad hoc PCI is common in MV/LM disease, particularly in 2-vessel proximal LAD disease.
• Significant variation in ad hoc PCI use among hospitals and patient factors (diabetes, low ejection fraction) warrants attention.
• A systems approach to standardize heart team consultation and shared decision-making is recommended for all hospitals.