Characteristics and Outcomes of PCI Among Patients Ineligible for Surgical Revascularization in the Veterans Affairs Healthcare System.

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Christopher P Kovach, Jerry Lipinski, Elise C Mesenbring, Peter Boulos, Abby Pribish, Michael Sola, Thomas J Glorioso, William F Fearon, Robert W Yeh, Stephen W Waldo
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引用次数: 0

Abstract

Background: Ineligibility for surgical revascularization is increasingly prevalent and associated with increased mortality after percutaneous coronary intervention (PCI). High-quality, contemporary, multicenter data regarding clinical outcomes after PCI is scarce and poses a barrier to clinical decision-making for surgically ineligible patients. The aim of this study was to describe and compare the clinical characteristics, institutional variation, and longitudinal outcomes of PCI among surgically eligible and ineligible patients in the Veterans Affairs Healthcare System.

Methods: Patients with left main and/or multivessel coronary artery disease undergoing index PCI between October 1, 2017 and September 30, 2022 were identified and the prevalence of surgical ineligibility determined by review of the electronic medical record. The association between surgical ineligibility and mortality and major adverse cardiovascular events (MACE; death, myocardial infarction, repeat revascularization, and stroke) was assessed.

Results: A total of 6192 patients with left main and/or multivessel coronary artery disease (842 surgically ineligible and 5350 surgically eligible) underwent PCI during the study period. After adjustment, surgical ineligibility was associated with a significantly decreased time to mortality (time ratio, 0.801 [95% CI, 0.662-0.970]) over a median 1045-day (interquartile range, 583-1600) follow-up period, though not associated with composite MACE (time ratio, 0.859 [95% CI, 0.685-1.078]). After adjustment for target lesion characteristics and procedural complexity, the association between surgical ineligibility and mortality was attenuated (time ratio, 0.842 [95% CI, 0.688-1.030]).

Conclusions: Ineligibility for surgical revascularization was associated with increased risk of long-term mortality after PCI. The risk of adverse outcomes after PCI, however, was similar among surgically eligible and ineligible patients after adjusting for measured comorbidities, coronary anatomic features, and procedural complexity.

退伍军人事务医疗系统中不适合外科血运重建术患者PCI的特点和结果。
背景:不适合手术血运重建术越来越普遍,并与经皮冠状动脉介入治疗(PCI)后死亡率增加有关。关于PCI术后临床结果的高质量、现代、多中心数据很少,这对不符合手术条件的患者的临床决策构成了障碍。本研究的目的是描述和比较退伍军人事务医疗保健系统中符合手术条件和不符合手术条件的患者的PCI的临床特征、制度差异和纵向结果。方法:对2017年10月1日至2022年9月30日期间接受PCI的左主干和/或多支冠状动脉疾病患者进行识别,并通过审查电子病历确定手术不合格的发生率。手术不适宜性与死亡率和主要不良心血管事件(MACE;评估死亡、心肌梗死、重复血运重建术和卒中)。结果:在研究期间,共有6192例左主干和/或多支冠状动脉疾病患者(842例手术不合格,5350例手术合格)接受了PCI治疗。调整后,在中位1045天(四分位间距,583-1600)随访期间,手术不合格与从死亡到死亡的时间(时间比,0.801 [95% CI, 0.662-0.970])显著降低相关,但与复合MACE无关(时间比,0.859 [95% CI, 0.685-1.078])。调整目标病变特征和手术复杂性后,手术不适宜性与死亡率之间的相关性减弱(时间比,0.842 [95% CI, 0.688-1.030])。结论:不适合外科血运重建术与PCI术后长期死亡风险增加相关。然而,在调整了测量的合并症、冠状动脉解剖特征和手术复杂性后,符合手术条件和不符合手术条件的患者的PCI术后不良结局风险相似。
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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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