Complex High-risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Non-surgical Centres

Shamkhani, Warkaa; Rashid, Muhammad; Moledina, Saadiq; Ludman, Peter; Curzen, Nick; Wijeysundera, Harindra C.; Grines, Cindy L.; Mamas, Mamas A.

Abstract

Background
Limited data are available on complex, high-risk percutaneous coronary intervention (CHiP) trends and outcomes in non-surgical centres (NSC), particularly in healthcare systems where most centers are NSCs.

Methods
Using data from a national registry, we studied the characteristics and outcomes of CHiP procedures performed for stable angina between 2006 and 2017 according to the presence or absence of on-site surgical cover. Multivariate regression analyses and propensity score matching were used to determine risks for in-hospital death, major bleeding, and major cardiovascular or cerebral events (MACCE).

Results
Out of 134,730 CHiP procedures, 42,433 (31.5%) were performed in NSCs, increasing from 12.5% in 2006 to 42% in 2017. Compared with surgical centres (SCs), patients who had a CHiP procedure undertaken in NSCs were, on average, 2.4 years older and had a greater prevalence of cardiovascular risks. Common CHiP procedures performed in NSCs included poor LV function 41.6%), chronic renal failure (38.8%), and CTO PCI (31.1%). NSC-based CHiP is associated with lower mortality (aOR: 0.7 (0.5-0.8)) and major bleeding odds (aOR: 0.7 (0.6-0.8)). In both groups, MACCE odds were similar (aOR: 1.0 (0.9-1.1).

Conclusion
CHiP numbers have steadily increased in NSCs. NSCs patients were older and had a higher prevalence of cardiovascular risks than the SCs patients. Mortality and major bleeding odds were significantly lower in those cases undertaken in NSCs, although MACCE odds were not different between the groups.

• Journal Article Type: Article
• Acceptance Date: Jan 1, 2024
• Online Publication Date: Jan 11, 2024
• Publication Date: 2024-01
• Deposit Date: Jan 12, 2024
• Journal: Canadian Journal of Cardiology
• Print ISSN: 0828-282X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.cjca.2024.01.003
• Keywords: Cardiology and Cardiovascular Medicine
• Additional Information: This article is maintained by: Elsevier; Article Title: Complex High-risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Non-surgical Centres; Journal Title: Canadian Journal of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.cjca.2024.01.003; Content Type: article; Copyright: © 2024 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.