Short-Term Clinical Outcomes of Complex Percutaneous Coronary Intervention in Patients Declined for Coronary Artery Bypass Grafting: A Contemporary Real-World Registry

Abstract Background: Coronary artery bypass grafting (CABG) is recommended as the optimal revascularization strategy in pref-erence to PCI in patients with multivessel disease and interme-diate to high SYNTAX scores.However, PCI seems appropriate for patients deemed surgically ineligible or refused the opera-tion. Aim of Study: This study aimed to the short-term major adverse cardiac and cerebrovascular events (MACCE) in pa-tients with multivessel complex coronary anatomy, defined as SYNTAX score above 22, undergoing non-emergent PCI who were indicated for CABG but either they were rejected by the surgeons, or they refused it. Patients and Methods: Our registry was conducted on 193 patients throughout a 6-month recruitment period and subse-quently followed-up for in-hospital and 6- month mortality and MACCE.
Results: Regarding the in- Hospital study outcomes, the mortality was 3%, and the MACCE occurred in 7%, while in the 6-month outcomes, the mortality was 4.5%, and the MAC-CE occurred in 17.5%. When comparing the intermediate to high SYNTAX score groups, there was a statistically signifi-cant increase in both in-h Hospital and short-termmortality and MACCE in the high SYNTAX score group but no significant difference regarding the incidence of contrast-induced nephrop-athy. SYNTAX II score ≥41 (OR 3.9, 95% CI 1.7-9.1, p=.001) and incomplete revascularization (OR5.4, 95% CI 2.1-13.7, p<.001) were independent predictors for short-term MACCE. Conclusions: Patients with high SYNTAX scores portend a significantly higher in-hospital and 6- month MACCE and mor-tality. When considering complex multivessel PCI, one should consider the benefits of achievement of complete revasculari-zation and the risks in patients with higher SYNTAX II scores.