Abstract 13188: Subsequent Revascularization in "No Option" Patients with Refractory Angina: Etiology and Outcome
Background: An increasing number of patients with advanced coronary artery disease have refractory angina despite maximal pharmacological therapy and are suboptimal candidates for revascularization. These patients are frequently termed “no option” or “nonrevascularizable” patients. Yet, many of these patients subsequently undergo revascularization. We sought to determine the incidence, etiology and outcome of revascularization in the “no option” patient.
Methods: Using a comprehensive, prospective refractory angina database, 342 of 1032 (33.1%) patients subsequently underwent revascularization at a median duration of 2.2 years (274 (26.5%) PCI, 44 (4.3%) CABG and 24 (2.3%) both). Detailed angiographic records were available for 181 PCI patients including 302 lesions. The reason for subsequent PCI was classified as: 1A and B new lesion-native and graft, 2A and B restenosis-native and graft; 3A and B existing lesion-native and graft; 4 new therapy/CTO (Table 1).
Results: Based on the most critical lesion, patients who required PCI for an existing lesion (7.6%/yr) and those undergoing CABG (6.1%/yr) had higher mortality compared to patients with new lesions (3.6%/yr), restenosis (5.0%/yr), and new therapy/CTO (4.7%/yr) (P=NS).
Conclusions: At 2.2 years following initial diagnosis, 33.1% of “no option” patients required subsequent revascularization. The most frequent reason for PCI was a new lesion in 48%. Mortality was highest in patients requiring PCI for an existing lesion or CABG.
- © 2012 by American Heart Association, Inc.