Characteristics and outcomes of percutaneous coronary intervention among patients initially referred for CABG

Coronary artery bypass grafting (CABG) ineligibility is associated with increased mortality in patients undergoing PCI. Limited data exist about CABG-eligible patients who decline surgery and opt for PCI.

National Cardiovascular Data Repository CathPCI data from 2018 to 2024 at two high-volume PCI centers was used to identify patients that had surgical consultation prior to PCI. Baseline characteristics and in-hospital outcomes were compared between patients who were turned down for surgery (CABG-ineligible) and those who were offered surgery but declined (CABG-eligible).

The cohort included 388 patients (313 CABG-ineligible and 75 CABG-eligible). CABG-ineligible patients were younger (70.4 vs 73.4 years; p = 0.01) and had higher rates of chronic lung disease, diabetes, and frailty, but with no difference in lesion complexity between the groups. PCI in the CABG-ineligible group was more likely urgent, emergent, or salvage, including STEMI and NSTEMI. Overall, PCI technical success was high, 92.9%, and in-hospital mortality was 4.8% in CABG-ineligible versus 2.7% in the CABG-eligible group (p = 0.54). There was no difference in bleeding, myocardial infarction, cardiogenic shock, cardiac arrest, or new-onset dialysis.

Among patients who underwent PCI after referral for CABG, technical success was high and in-hospital mortality was acceptable in patients who were deemed eligible or ineligible for CABG. Further study is warranted to examine long-term outcomes of PCI in CABG-ineligible patients versus those who decline CABG.