Yukiko Matsumura-Nakano1, Hiroki Shiomi1, Takeshi Morimoto2, Yutaka Furukawa3, Yoshihisa Nakagawa4, Kazushige Kadota5, Kenji Ando6, Kyohei Yamaji6, Satoshi Shizuta1, Ryuzo Sakata7, Michiya Hanyu8, Mitsuomi Shimamoto9, Tatsuhiko Komiya10, Takeshi Kimura1. 1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine. 2. Department of Clinical Epidemiology, Hyogo College of Medicine. 3. Department of Cardiology, Kobe City Medical Center General Hospital. 4. Department of Cardiovascular Medicine, Shiga University of Medical Science. 5. Department of Cardiovascular Medicine, Kurashiki Central Hospital. 6. Department of Cardiology, Kokura Memorial Hospital. 7. Department of Cardiovascular Surgery, Osaka Red Cross Hospital. 8. Department of Cardiovascular Surgery, Kitano Hospital. 9. Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital. 10. Department of Cardiovascular Surgery, Kurashiki Central Hospital.
Abstract
BACKGROUND: In patients with severe coronary artery disease (CAD) requiring coronary revascularization, the prevalence of surgical ineligibility and its clinical effect on long-term outcomes remain unclear.Methods and Results: Among 15,939 patients with first coronary revascularization in the CREDO-Kyoto percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2, we identified 3,982 patients with triple-vessel or left main disease (PCI: n=2,188, and CABG: n=1,794). Surgical ineligibility as documented in hospital charts was present in 142 (6.5%) of 2,188 PCI-patients, which was mainly related to comorbidities and advanced age. The cumulative 5-year incidence of the primary outcome measure (all-cause death/myocardial infarction/stroke) was much higher in PCI-patients with surgical ineligibility than in PCI-patients without surgical ineligibility and in CABG-patients (52.5%, 27.6%, and 24.0%, respectively, log-rank P<0.001). After adjusting for confounders, the excess risk of PCI-patients with surgical ineligibility relative to CABG-patients was substantial (hazard ratio [HR] 1.97, 95% CI 1.51-2.58, P<0.001), while the excess risk of PCI-patients without surgical ineligibility relative to CABG-patients was modest, but remained significant (HR 1.37, 95% CI 1.19-1.59, P<0.001). CONCLUSIONS: Among patients with severe CAD, PCI-patients with surgical ineligibility had worse long-term outcomes as compared with those without surgical ineligibility and CABG-patients.
BACKGROUND: In patients with severe coronary artery disease (CAD) requiring coronary revascularization, the prevalence of surgical ineligibility and its clinical effect on long-term outcomes remain unclear.Methods and Results: Among 15,939 patients with first coronary revascularization in the CREDO-Kyoto percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2, we identified 3,982 patients with triple-vessel or left main disease (PCI: n=2,188, and CABG: n=1,794). Surgical ineligibility as documented in hospital charts was present in 142 (6.5%) of 2,188 PCI-patients, which was mainly related to comorbidities and advanced age. The cumulative 5-year incidence of the primary outcome measure (all-cause death/myocardial infarction/stroke) was much higher in PCI-patients with surgical ineligibility than in PCI-patients without surgical ineligibility and in CABG-patients (52.5%, 27.6%, and 24.0%, respectively, log-rank P<0.001). After adjusting for confounders, the excess risk of PCI-patients with surgical ineligibility relative to CABG-patients was substantial (hazard ratio [HR] 1.97, 95% CI 1.51-2.58, P<0.001), while the excess risk of PCI-patients without surgical ineligibility relative to CABG-patients was modest, but remained significant (HR 1.37, 95% CI 1.19-1.59, P<0.001). CONCLUSIONS: Among patients with severe CAD, PCI-patients with surgical ineligibility had worse long-term outcomes as compared with those without surgical ineligibility and CABG-patients.