Prevalence, Trends, and Outcomes of Higher-Risk Percutaneous Coronary Interventions Among Patients Without Acute Coronary Syndromes

Ann Iverson, Larissa I. Stanberry, Peter Tajti, Ross Garberich, Amber Antos, M. Nicholas Burke, Ivan Chavez, Mario Gössl, Timothy D. Henry, Daniel Lips, Michael Mooney, Anil Poulose, Paul Sorajja, Jay Traverse, Yale Wang, Steven Bradley, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background/purpose: Patients and lesions at a higher procedural risk for percutaneous coronary intervention (PCI) are an understudied population. We examined the frequency, clinical characteristics, and outcomes of higher risk and non-higher risk PCIs at a large tertiary center. Methods/materials: The following procedures were considered higher risk: unprotected left main PCI, chronic total occlusion PCI, PCI requiring atherectomy, multivessel PCI, bifurcation PCI, PCI in prior coronary artery bypass graft surgery (CABG) patients, pre-PCI left ventricular ejection fraction ≤30%, or use of hemodynamic support. Results: Of the 1975 PCIs performed from 6/29/09 to 12/30/2016 in patients without acute coronary syndromes, 1230 (62%) were higher risk. Patients undergoing higher risk PCI were more likely to have a history of CABG, myocardial infarction, PCI, cerebrovascular disease, peripheral arterial disease, or congestive heart failure. Higher risk PCIs required more stents (2.0 vs. 1.0, p < 0.001), and had longer median fluoroscopy times (17.3 vs. 8.5 min, p < 0.001) and higher median contrast doses (160 vs. 120 mL, p < 0.001). In higher risk PCIs, the risks for technical failure and periprocedural complications were 2.9 (95% CI 1.2–7.4) times and 2.2 (95% CI 0.9–5.4) times higher as compared with non-higher risk PCI procedures. Conclusions: In summary, over half of the PCIs performed in non-acute coronary syndrome patients were higher risk and were associated with lower odds of technical success and higher periprocedural complication rates as compared with non-higher risk PCIs. We examined the frequency, clinical characteristics, and outcomes of higher risk and non-higher risk PCIs at a large tertiary center. Higher risk PCI was associated with lower odds of technical and procedural success and higher odds of procedural complications as compared with non-higher risk PCI. However, the risk/benefit ratio may still be favorable for many of these higher-risk patients and should be estimated on a case by case basis.

Original languageEnglish (US)
Pages (from-to)289-292
Number of pages4
JournalCardiovascular Revascularization Medicine
Volume20
Issue number4
DOIs
StatePublished - Apr 2019

Keywords

  • Bifurcation lesions
  • Chronic total occlusions (CTO)
  • Multivessel PCI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Iverson, A., Stanberry, L. I., Tajti, P., Garberich, R., Antos, A., Burke, M. N., Chavez, I., Gössl, M., Henry, T. D., Lips, D., Mooney, M., Poulose, A., Sorajja, P., Traverse, J., Wang, Y., Bradley, S., & Brilakis, E. S. (2019). Prevalence, Trends, and Outcomes of Higher-Risk Percutaneous Coronary Interventions Among Patients Without Acute Coronary Syndromes. Cardiovascular Revascularization Medicine, 20(4), 289-292. https://doi.org/10.1016/j.carrev.2018.07.017