Abstract 3915: PCI in Asymptomatic Outpatients Undergoing Cardiac Catheterization: Results from the American College of Cardiology - National Cardiovascular Data Registry (ACC-NCDR®)
Background: Outside the setting of ACS, the primary benefit of percutaneous coronary intervention (PCI) is to reduce angina and improve quality of life. The role of PCI in asymptomatic patients referred for cardiac catheterization is controversial as it is not known whether the potential benefits outweigh procedural risks.
Methods: We analyzed data from the ACC National Cardiovascular Data Registry to identify outpatients referred for catheterization to evaluate coronary artery disease at hospitals performing elective PCI. Symptom status was determined by operators at the time of the procedure. Asymptomatic was defined as no report of angina or heart failure. We compared indications, angiographic findings, use of PCI, and procedural complications of asymptomatic and symptomatic patients.
Results: In 2005, 330,938 patients underwent outpatient catheterization at 454 PCI capable hospitals, and of these 39,685 (12.0%) were asymptomatic. Compared with symptomatic patients, asymptomatic patients were less likely to have a history of myocardial infarction, heart failure, or prior PCI (all P<0.001), and more likely to have had a positive stress test (73.1% Vs 61.9%, P<0.001). Asymptomatic patients were more likely to have insignificant disease (55.0% Vs 35.9%, P<0.001) and had a lower incidence of 3 vessel (4.5% Vs 12.5%, P<0.001) or left main disease (2.6% Vs 5.8%). PCI was performed in 10,212 (25.7%) asymptomatic patients. Asymptomatic patients who received PCI had significantly higher rates of procedural complications compared with asymptomatic patients who did not undergo PCI (Table⇓).
Conclusion: Asymptomatic patients referred for angiography frequently undergo PCI, usually in response to an abnormal stress test. The rate of major complications is low but clinically significant. More evidence is needed to determine whether there are quantifiable benefits in conducting PCI in these asymptomatic patients and insure that the benefits outweigh the risks.