Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery
Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes. This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel c...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2023-02, Vol.16 (3), p.261-273 |
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| creator | Salisbury, Adam C. Grantham, J. Aaron Brown, W. Morris Ballard, William L. Allen, Keith B. Kirtane, Ajay J. Argenziano, Michael Yeh, Robert W. Khabbaz, Kamal Lasala, John Kachroo, Puja Karmpaliotis, Dimitri Moses, Jeffrey Lombardi, William L. Nugent, Karen Ali, Ziad Gosch, Kensey L. Spertus, John A. Kandzari, David E. |
| description | Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes.
This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG).
Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months.
A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 ± 12.2 before and 15.0 ± 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons’ estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 19.7; P < 0.0001).
Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons’ estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients’ health status improved significantly through 6 months.
[Display omitted] |
| doi_str_mv | 10.1016/j.jcin.2023.01.003 |
| format | Article |
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This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG).
Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months.
A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 ± 12.2 before and 15.0 ± 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons’ estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 19.7; P < 0.0001).
Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons’ estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients’ health status improved significantly through 6 months.
[Display omitted]</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2023.01.003</identifier><identifier>PMID: 36792252</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>coronary artery disease ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - therapy ; Drug-Eluting Stents ; health status ; Humans ; multivessel coronary disease ; patient-reported outcomes ; percutaneous coronary intervention ; Percutaneous Coronary Intervention - adverse effects ; quality of life ; Risk Factors ; Treatment Outcome</subject><ispartof>JACC. Cardiovascular interventions, 2023-02, Vol.16 (3), p.261-273</ispartof><rights>2023 American College of Cardiology Foundation</rights><rights>Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-b6282cb11ced2acdb7854b40e4271d7bc8159f9299c86c71487e041ff64a72fc3</citedby><cites>FETCH-LOGICAL-c356t-b6282cb11ced2acdb7854b40e4271d7bc8159f9299c86c71487e041ff64a72fc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jcin.2023.01.003$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3541,27915,27916,45986</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36792252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salisbury, Adam C.</creatorcontrib><creatorcontrib>Grantham, J. Aaron</creatorcontrib><creatorcontrib>Brown, W. Morris</creatorcontrib><creatorcontrib>Ballard, William L.</creatorcontrib><creatorcontrib>Allen, Keith B.</creatorcontrib><creatorcontrib>Kirtane, Ajay J.</creatorcontrib><creatorcontrib>Argenziano, Michael</creatorcontrib><creatorcontrib>Yeh, Robert W.</creatorcontrib><creatorcontrib>Khabbaz, Kamal</creatorcontrib><creatorcontrib>Lasala, John</creatorcontrib><creatorcontrib>Kachroo, Puja</creatorcontrib><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Moses, Jeffrey</creatorcontrib><creatorcontrib>Lombardi, William L.</creatorcontrib><creatorcontrib>Nugent, Karen</creatorcontrib><creatorcontrib>Ali, Ziad</creatorcontrib><creatorcontrib>Gosch, Kensey L.</creatorcontrib><creatorcontrib>Spertus, John A.</creatorcontrib><creatorcontrib>Kandzari, David E.</creatorcontrib><creatorcontrib>OPTIMUM Investigators</creatorcontrib><title>Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes.
This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG).
Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months.
A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 ± 12.2 before and 15.0 ± 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons’ estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 19.7; P < 0.0001).
Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons’ estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients’ health status improved significantly through 6 months.
[Display omitted]</description><subject>coronary artery disease</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - therapy</subject><subject>Drug-Eluting Stents</subject><subject>health status</subject><subject>Humans</subject><subject>multivessel coronary disease</subject><subject>patient-reported outcomes</subject><subject>percutaneous coronary intervention</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>quality of life</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtOwzAURS0E4lPYAAPkIZME20nsRGKCyq9Sq1aijE3iPBdXblLspFJ307V0ZaS0MGT03uDcK92D0DUlISWU383DuTJVyAiLQkJDQqIjdE5TwQPBSXLc_VnEg1Rk6Rm68H5OCCeZYKfoLOIiYyxh5-hj3DaqXoDHtcYjKI3KLZ5-gsuXazyxrceT_mC70bXbbkatbcwKvAeLa4eHoBs8yk2F-w-P282gAmtmprDwg-O31s3ArS_Ric6th6vD7aH356dp_zUYjl8G_YdhoKKEN0HBWcpUQamCkuWqLESaxEVMIGaClqJQKU0ynbEsUylXgsapABJTrXmcC6ZV1EO3-96lq79a8I1cGK_A2ryCuvWSCSFiwhPKOpTtUeVq7x1ouXRmkbu1pETuzMq53JmVO7OSUNmZ7UI3h_62WED5F_lV2QH3ewC6lSsDTnploOr2GAeqkWVt_uv_BvnSjIo</recordid><startdate>20230213</startdate><enddate>20230213</enddate><creator>Salisbury, Adam C.</creator><creator>Grantham, J. 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Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salisbury, Adam C.</au><au>Grantham, J. Aaron</au><au>Brown, W. Morris</au><au>Ballard, William L.</au><au>Allen, Keith B.</au><au>Kirtane, Ajay J.</au><au>Argenziano, Michael</au><au>Yeh, Robert W.</au><au>Khabbaz, Kamal</au><au>Lasala, John</au><au>Kachroo, Puja</au><au>Karmpaliotis, Dimitri</au><au>Moses, Jeffrey</au><au>Lombardi, William L.</au><au>Nugent, Karen</au><au>Ali, Ziad</au><au>Gosch, Kensey L.</au><au>Spertus, John A.</au><au>Kandzari, David E.</au><aucorp>OPTIMUM Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2023-02-13</date><risdate>2023</risdate><volume>16</volume><issue>3</issue><spage>261</spage><epage>273</epage><pages>261-273</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes.
This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG).
Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months.
A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 ± 12.2 before and 15.0 ± 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons’ estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 19.7; P < 0.0001).
Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons’ estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients’ health status improved significantly through 6 months.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36792252</pmid><doi>10.1016/j.jcin.2023.01.003</doi><tpages>13</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | JACC. Cardiovascular interventions, 2023-02, Vol.16 (3), p.261-273 |
| issn | 1936-8798 1876-7605 |
| language | eng |
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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | coronary artery disease Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - therapy Drug-Eluting Stents health status Humans multivessel coronary disease patient-reported outcomes percutaneous coronary intervention Percutaneous Coronary Intervention - adverse effects quality of life Risk Factors Treatment Outcome |
| title | Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery |
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