B-23 | Evaluating the Safety of High-Risk Percutaneous Coronary Intervention at Non-Cardiac Surgery Sites: An Observational Cohort Study

Abstract

Contemporary data is needed to evaluate the safety of high-risk percutaneous coronary intervention (PCI) at non-CV surgery (CVS) sites compared to similar cases performed at CVS sites. Observational cohort study of high-risk patients undergoing PCI of select high-risk lesions in CVS and non-CVS sites, within a large integrated healthcare system in Northern California between 01/2011-03/2019. Using ICD-9/10 codes, we defined high-risk patients as those with decompensated heart failure, chronic kidney disease or an ejection fraction (EF) ≤30%. High risk or ‘type C’ lesions (diffuse disease ≥20mm, proximal lesions, moderate-severe calcification, degenerated vein grafts, and multi-vessel disease) were identified from validated procedural databases. We excluded patients with ST elevation myocardial infarction, cardiac arrest ≤24 hours, cardiogenic shock, or PCI transfers to CVS sites. Primary outcome was a composite of 12-month all-cause mortality and need for emergent bypass surgery. Crude hazard ratio (HR) and 95% confidence interval (CI) for the primary outcome, non-CVS sites versus CVS sites was estimated using Cox Proportional Hazards model without controlling for any baseline covariates. Propensity score method was used to evaluate the effect of CVS site on the composite outcome using Cox Proportional Hazards model controlling for baseline covariates fitted by inverse probability of treatment weighting (IPTW) estimation. Out of a total of 19,525 patients, 15,690 (80.4%) underwent high-risk PCI at a CVS site, whereas 3,835 (19.6%) at a non-CVS site. Mean age was 67 (SD 11.5) years, with 27.2% women. PCI indication was non-ST elevation ACS for 73.8% of patients. Compared to CVS sites, the crude HR for the composite outcome for non-CVS site was 1.009 (95%CI: 1.005-1.013); after IPTW the risk-adjusted HR was 0.999 (95%CI: 0.996-1.002). In select high-risk patients undergoing PCI of select high risk lesions, there is no significant difference in rates of emergent CABG and 12-month all-cause mortality between CVS and non-CVS sites. Limitations include the observational nature of the analysis which may not fully account for residual confounding.