Author + information
- David M. Shavelle1,
- Ajay J. Kirtane2,
- Theodore L. Schreiber3,
- Neel K. Kapasi1,
- William W. O’Neill4,
- Jeffery W. Moses2,
- Jeffrey Popma5 and
- Ray V. Matthews1
- 1Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA
- 2Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY
- 3Detroit Medical Center, Cardiovascular Institute, Detroit, MI
- 4Henry Ford Hospital, Detroit, MI
- 5Beth Israel Deaconess Medical Center, Boston, MA
In observational studies of patients undergoing percutaneous coronary intervention (PCI), surgical ineligibility is associated with increased mortality. Whether the use of hemodynamic support during PCI can mitigate the adverse prognostic importance of surgical ineligibility is unknown.
We sought to evaluate the association between the request for surgical consultation (presumed surgical ineligibility) prior to PCI and clinical outcomes in 427 patients with multi-vessel coronary artery disease or unprotected left main disease and severely reduced left ventricular systolic function undergoing PCI assisted by hemodynamic support (intra-aortic balloon pump or Impella) from the PROTECT II randomized trial. Patients in whom surgical consultation was requested prior to PCI (n=201) were compared to those in whom surgical consultation was not requested (n=226). The primary endpoint of this analysis was the composite of 90 day major adverse cardiac and cerebrovascular events (MACCE).
Demographic and procedural variables were similar between patients receiving surgical consultation and patients not receiving surgical consultation with the exception that the prevalence of prior coronary artery bypass surgery was significantly higher in patients not receiving surgical consultation (42.0% vs 25.4%, p<0.001); these patients additionally had a higher proportion of lesions within a saphenous vein graft, and a greater prevalence of moderate/severe vessel calcification. MACCE at 90 days was similar in patients receiving surgical consultation compared to patients not receiving surgical consultation, 23.4% vs. 29.0%, respectively, p=0.188.
In this high-risk cohort of patients undergoing hemodynamically supported PCI, clinical outcome was not associated with an antecedent request for surgical consultation (presumed surgical ineligibility). Whether the use of hemodynamically supported PCI can lessen the risk conferred by surgical ineligibility remains requires further study.