Abstract 18170: Prevalence, Predictors and 1-year Outcomes of ad hoc PCI for Complex Coronary Artery Disease : A Patient-centered Observational Study
Introduction: 2011 ACCF/AHA coronary artery bypass grafting (CABG) guideline and percutaneous coronary intervention (PCI) guideline recommended the forbidden use of ad hoc PCI (PCI immediately after coronary angiography) for complex coronary artery disease (CAD). The aim of this study is to explore the prevalence, risk factors and outcomes of ad hoc PCI for three-vessel or left-main CAD.
Hypothesis: Complex CAD patients treated by ad hoc PCI have worse 1-year outcomes comparing with staged treatment.
Methods: Between July 2011 and September 2012, patients diagnosed as three-vessel or left-main CAD at Fuwai hospital were consecutively enrolled. We reviewed medical records to abstract detailed in-hospital information. The Corelab calculated SYNTAX Scores according to coronary angiograms. We conducted follow-up interview at 12 months after index hospitalization. The end point was major adverse cerebral and cardic event (MACCE) including death, myocardial infarction, stroke and additional revascularizatin. Patients were then divided into ad hoc PCI group and staged treatment group. Binary viariables logistic model and Cox model were uesd for baseline and 1-year outcomes comparison respectively.
Results: 1746 patients were consecutively enrolled. 36.7% (640) undertook ad hoc PCI, 63.3% (1106) received staged treatment (290 choosed medical therapy, 113 undertook non-ad hoc PCI, 688 received CABG). Compared with staged treatment, the patients in ad hoc PCI group were younger (ad hoc PCI: 59.3±10.6, staged treatment group: 62.2±9.5, p=0.002), had lower SYNTAX Scores (ad hoc PCI: 21.1±8.0, staged treatment group: 26.6±9.7, p<0.001) and SinoSCOREs (ad hoc PCI:0.5±2.9, staged treatment group: 1.7±3.6, p<0.001). After adjustment for coronary anatomy complexity and cardiac surgery risks using Cox model, ad hoc PCI was associated with significantly higher rates of MACCE (HR=0.644, 95% confidential interval:0.446-0.930, p=0.019) and additional revascularization (HR=0.485, 95% confidential interval:0.306-0.769, p=0.002).
Conclusions: For patients with 3-vessel disease or left main CAD, 36.7% undertook ad hoc PCI, which was associated with higher rates of MACCE and additional revascularization.
Author Disclosures: C. Rao: None. S. Hu: None. Z. Zheng: None. K. Hua: None. X. Yuan: None. H. Zhang: None.
- © 2014 by American Heart Association, Inc.