58 Percutaneous coronary intervention in patients turned down for surgical revascularization: a single-centre experience

Aim We aimed to evaluate the reasons for surgical ineligibility and in-hospital outcome of percutaneous coronary intervention (PCI) in these patients at a large tertiary centre. Methods We performed a retrospective analysis of prospectively collected data on surgical turndown patients who underwent PCI between April 2013 and November 2020. Data were collected from the institutional electronic database. Results Of 473 patients, 69.8% were male with mean age of 72±11 years and mean body mass index of 29±6 kg/m2. Turndown reasons were documented in 52.4 % of patients and mainly included the perceived frailty of the patient with associated comorbidities and/or the quality of distal coronary arteries. Elective cases with stable angina constituted 216 patients (45.7%) and urgent cases with acute coronary syndromes constituted 257 patients (54.3%). Mean hospital stay was 4±5 days. Procedural success was documented in 457 out of 473 patients (96.6%). Adjunctive tools included physiological assessments in 34 patients (7.2%), intracoronary imaging in 97 patients (20.5%), rotational atherectomy in 96 patients (20.3%), laser atherectomy in 12 patients (2.5%) and lithotripsy in 3 patients (0.6%). In-hospital complications included major adverse cardiac events in 32 patients (6.8%), death in 12 patients (2.5%), myocardial infarction in 21 patients (4.4%), ischaemic stroke in 1 patient (0.2%), coronary perforation in 7 patients (1.5%), repeat target vessel revascularization in 6 patients (1.3%), major access-site bleeding in 2 patients (0.4%), aortic dissection in 1 patient (0.2%) and new acute kidney injury requiring dialysis in 1 patient (0.2%). Conclusions In real-world data, the process of determining suitability for surgical revascularization is often complex. PCI in surgically ineligible patients is generally safe and effective. Conflict of Interest None