Surgical Ineligibility and Mortality Among Patients with Unprotected Left Main or Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention
Background—Decisions to proceed with surgical versus percutaneous revascularization for multivessel coronary artery disease are often based on subtle clinical information that may not be captured in contemporary registries. The present study sought to evaluate the association between surgical ineligibility documented in the medical record and long-term mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention (PCI).
Methods and Results—All subjects undergoing non-emergent PCI for unprotected left main or multivessel coronary artery disease were identified at two academic medical centers from 2009 - 2012. Documentation of surgical ineligibility was assessed through review of the electronic medical record. Cox proportional hazard models adjusted for known mortality risk factors were created to assess long-term mortality in patients with and without documentation of surgical ineligibility. Among 1013 subjects with multivessel coronary artery disease, 218 (22 %) were deemed ineligible for coronary artery bypass graft surgery. The most common explicitly cited reasons for surgical ineligibility in the medical record were poor surgical targets (24 %), advanced age (16 %) and renal insufficiency (16 %). After adjustment for known risk factors, documentation of surgical ineligibility remained independently associated with an increased risk of in-hospital (OR: 6.26, 95% CI: 2.16 - 18.15, P<0.001) and long-term mortality (HR: 2.98, 95% CI: 1.88 - 4.72, P<0.001) after PCI.
Conclusions—Documented surgical ineligibility is common and associated with significantly increased long-term mortality among patients undergoing PCI with unprotected left main or multivessel coronary disease, even after adjustment for known risk factors for adverse events during percutaneous revascularization.
- Received June 3, 2014.
- Revision received October 6, 2014.
- Accepted October 8, 2014.