Abstract
The objective of this study is to evaluate completeness of coronary revascularization in patients with complex stable coronary artery disease (SCAD) who underwent percutaneous coronary interventions (PCI), but a surgical revascularization indicated according to 2018 European Society of Cardiology guidelines. The optimal mode of revascularization for SCAD should take into account clinical, anatomic, and procedural characteristics-including anticipated completeness of revascularization-and modality of treatment should be discussed by a Heart Team. Among patients enrolled in the APpropriAteness of percutaneous Coronary interventions in patients with ischemic heart disease study, we identified patients with complex SCAD. Rates of ad-hoc PCI and documented heart team discussion were reported stratified by guideline recommended mode of revascularization. Completeness of revascularization was assessed by an angiographic core laboratory using residual SS (rSS) ≤ 8 and SYNTAX Revascularization Index (SRI) ≥ 70%. Among 336 PCI patients with SCAD, 182 (54.2%) had complex coronary disease and 152 underwent ad-hoc PCI (83.5%). Patients for whom surgery was the recommended revascularization option (9.3%) had a significantly and substantial higher rate of incomplete revascularization than patients for whom either mode of revascularization or PCI was recommended (61.3% vs 23.6% with rSS > 8, p < 0.001 and 77.4% vs 44.6% with SRI < 70%, p < 0.001). Patients with complex SCAD receiving percutaneous myocardial revascularization when surgery was recommended have substantially incomplete myocardial revascularization. These data support multidisciplinary decision-making in these patients and suggest considering anticipated completeness when deciding mode of coronary revascularization.
Original language | English |
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Pages (from-to) | 30-37 |
Number of pages | 8 |
Journal | Heart and Vessels |
Volume | 35 |
Issue number | 1 |
DOIs | |
Publication status | Published - Jan 2020 |
Keywords
- Aged
- Clinical Decision-Making
- Coronary Angiography/standards
- Coronary Artery Bypass/adverse effects
- Coronary Artery Disease/diagnostic imaging
- Female
- Guideline Adherence/standards
- Humans
- Male
- Middle Aged
- Patient Selection
- Percutaneous Coronary Intervention/adverse effects
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Retrospective Studies
- Risk Factors
- Treatment Outcome