Abstract 9559: Clinical Outcomes and Predictors of All-Cause Mortality After Complex High-risk and Indicated Revascularization Using Percutaneous Coronary Intervention

Abstract

Introduction: The concept of complex and high-risk indicated procedures using percutaneous coronary intervention (CHIP-PCI) has recently been defined. However, few studies have investigated the prognosis of patients after CHIP-PCI. Methods: CHIP-PCI was defined as a procedure satisfying at least one criterion each for both patient and procedure characteristics, as follows: patient characteristics [age (≥ 75 years old), low left ventricular ejection fraction (LVEF), diabetes mellitus, acute coronary syndrome, previous coronary artery bypass surgery, peripheral arterial disease, severe chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and severe valvular disease] and procedure characteristics [unprotected left main disease, degenerated saphenous or radial artery grafts, severely calcified lesions, last patent conduit, chronic total occlusions, multivessel disease, and use of mechanical circulatory support]. Between January 2017 and December 2018, we performed PCI for 695 consecutive patients in our hospital. Of these patients, CHIP-PCI was performed for 322 consecutive patients. Results: The survival rate was significantly lower in CHIP-PCI group than non-CHIP-PCI group (log-rank P < 0.01, Figure). Moreover, on Cox multivariate hazard analysis, age (≥ 75 years old) (hazard ratio: 4.01, 95% confidence interval: 1.92-8.38, p < 0.01), COPD (hazard ratio: 2.95, 95% confidence interval: 1.38-6.32, p < 0.01), low LVEF (hazard ratio: 3.35, 95% confidence interval: 1.55-7.22, p < 0.01), severe CKD (hazard ratio: 3.02, 95% confidence interval: 1.44-6.36, p < 0.01), and use of mechanical circulatory support (hazard ratio: 5.97, 95% confidence interval: 2.72-13.10, p < 0.01) remained significant predictors of mortality after CHIP-PCI.. Conclusions: The presence of advanced age, COPD, low LVEF, severe CKD, and mechanical circulatory support use might lead to worse clinical outcomes after CHIP-PCI.