Clinical characteristics and outcomes of myocardial infarction, stroke, and cardiovascular mortality among patients...

Complex High-risk Indicated Percutaneous Coronary Intervention (CHIP-PCI) addresses complex coronary artery disease in patients unsuitable for or declining surgery. Performing CHIP-PCI in non-surgical centres presents unique challenges requiring robust risk mitigation. CHIP-PCI was defined as PCI in any patient meeting at least one of the following criteria: PCI to left main stem, chronic total occlusion, severe coronary artery calcification (CAC), bifurcation lesions, left ventricular ejection fraction (LVEF) < 30%, serum creatinine > 200μmol/L, chronic dialysis, intra-aortic balloon pump use, previous coronary artery bypass graft, or age ≥ 80 years. Locally, the outcomes of major adverse cardiovascular events (MACE) - a composite of myocardial infarction, stroke, and cardiovascular mortality - and their associated factors after CHIP-PCI remain poorly understood. This study aims to evaluate 30-day MACE, patient characteristics and variables associated with mortality in CHIP-PCI.

This single-centre retrospective cohort study with 30-day follow-up utilised anonymous secondary data from CHIP-PCI patients treated at the Department of Cardiology, Hospital Raja Permaisuri Bainun between 1st January and 31st December 2024. Data extracted included demographics, comorbidities, laboratory investigations (low-density lipoprotein [LDL], serum creatinine, echocardiography findings), and intra- and postprocedural findings. Patients with missing data for ≥ 3 variables of interest were excluded. A multivariate binary logistic regression analysis was conducted to identify the variables associated with mortality post CHIP-PCI.

Of the 161 total patients, 146 (90.7%) were included in the analysis. Among these, 71.9% were male, and the mean age was 63.03 ± 10.19 years. Common comorbidities included hypertension (83.6%), diabetes mellitus (66.4%), elevated LDL (51.6%), serum creatinine > 200μmol/L (38.4%), prior Acute Coronary Syndrome (37.0%), chronic dialysis (30.1%), and LVEF < 30% (9.6%). Radial access was the most common approach (72.6%), and PCI was most frequently performed for severe CAC (46.6%). Intracoronary imaging was used in 43.8% of cases, and 39.0% required advanced calcium modification technique (atherectomy or intravascular lithotripsy). Most were single-lesion PCI (80.8%), with the left anterior descending artery (80.8%) being the most treated vessel. The 30-day MACE rate was 5.5% (4.8% mortality, 0.7% stroke, and 0% recurrent myocardial infarction). Multivariate analysis demonstrated that LVEF < 30% (AOR: 41.1, 95% CI: 1.1-1563.8, p = 0.04), severe CAC (AOR: 28.2, 95% CI: 1.3-619.3; p = 0.03), elevated LDL (AOR: 28.7, 95% CI: 1.2-701.1; p = 0.04), and readmission (AOR: 81.7, 95% CI: 4.1-1618.3, p < 0.001) were exploratory variables associated with 30-day mortality.

This study demonstrates that the 30-day MACE rate for CHIP-PCI was 5.5%, suggesting the procedure may be feasible with acceptable short-term outcomes in a nonsurgical centre. Severely reduced LVEF, severe CAC, elevated LDL levels, and hospital re-admission showed potential associations with 30-day mortality highlighting the need for optimised strategies for patient risk mitigation.