TY - JOUR
T1 - Prevalence, Trends, and Outcomes of Higher-Risk Percutaneous Coronary Interventions Among Patients Without Acute Coronary Syndromes
AU - Iverson, Ann
AU - Stanberry, Larissa I.
AU - Tajti, Peter
AU - Garberich, Ross
AU - Antos, Amber
AU - Burke, M. Nicholas
AU - Chavez, Ivan
AU - Gössl, Mario
AU - Henry, Timothy D.
AU - Lips, Daniel
AU - Mooney, Michael
AU - Poulose, Anil
AU - Sorajja, Paul
AU - Traverse, Jay
AU - Wang, Yale
AU - Bradley, Steven
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
The authors would like to thank the Minneapolis Heart Institute Foundation intern program funders, including the Abbott Northwestern Hospital Foundation, Ruth Stricker Dayton, Richard D. Kantrud, the Culp Family Foundation, Piper Jaffray, and many individual contributors for their ongoing support.
Funding Information:
Disclosures: One or more of the authors have disclosed potential conflicts of interest regarding the content herein. Dr. Burke reports consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis reports consulting/speaker honoraria from Abbott Vascular, ACIST, Amgen, Asahi, CSI, Elsevier, GE Healthcare, Medicure, Medtronic, and Nitiloop and research support from Boston Scientific and Osprey. He serves in the Board of Directors of the Cardiovascular Innovations Foundation and the Board of Trustees of the Society of Cardiovascular Angiography and Interventions. Dr. Traverse reports an NIH grant. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/4
Y1 - 2019/4
N2 - 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.
AB - 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.
KW - Bifurcation lesions
KW - Chronic total occlusions (CTO)
KW - Multivessel PCI
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U2 - 10.1016/j.carrev.2018.07.017
DO - 10.1016/j.carrev.2018.07.017
M3 - Article
C2 - 30054257
AN - SCOPUS:85050311331
SN - 1553-8389
VL - 20
SP - 289
EP - 292
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 4
ER -