Long-term outcomes in surgically ineligible patients managed with percutaneous coronary revascularization or medical therapy.

Abstract

The objective of the study was to report clinical outcomes of patients unsuitable for surgical coronary revascularization (CABG) treated with percutaneous revascularization (PCI) or medical therapy alone (MT). The decision to revascularize patients referred for CABG but who are unsuitable should be made at Heart Team meetings. The clinical outcomes in this important patient subset are not known, and while cases are considered individually, these decisions are not guided by robust data. Clinical data were analyzed for patients referred to the Heart Team for consideration of CABG over a 4-year period in a UK tertiary referral center. Outcome data for those managed with urgent PCI or MT were considered over a further 3-year period. 133 patients were treated with PCI and 117 with MT. MACE at 30days were no different between groups (MT 10.3% versus PCI 12.2%); however, at 1year MACE were higher in the MT group (MT 39.3% versus PCI 26.7%, P < 0.01). Log rank for MACE-free survival to 1 and 3years was significantly lower in the MT group [HR 1.77 (0.60-1.11); P < 0.001]. Residual SYNTAX was an independent predictor of death. MT [OR 1.75 (1.03-2.99); P = 0.04] and a residual SYNTAX score [OR 6.45 (2.53-16.45); P < 0.001] were independent predictors of MACE at 1year in the whole group. Our data reveal better outcomes in patients treated with PCI over MT at 1-3years in CABG-ineligible patients. Patients without complete revascularization have worse outcomes.