Using the risk of restenosis as a guide to triaging patients between surgical and percutaneous coronary revascularization.
BACKGROUND
Coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI) are strategies for treating coronary disease. Because the principal limitation of PCI is restenosis, CABG might be favored for those at high risk for restenosis. Using a clinical risk score for predicting restenosis, we examined whether patients with higher risks for restenosis were preferentially referred for CABG.


RESULTS
A procedural registry of 2320 revascularization patients from whom data on procedure type, demographics, comorbid conditions, health status, vessel anatomy, and outcomes were taken was analyzed. Patients were classified and scored into 3 categories of restenosis risk ranging from 11% to 44%, as defined by 8 preprocedural characteristics. The objective of this study was to describe referral patterns between PCI and CABG in each category of risk. 2060 patients underwent nonemergent revascularization. 1404 of the patients underwent PCI and 656 were treated with CABG. Among the patients at low and intermediate risk for restenosis, twice as many were referred to PCI. Among those at the highest risk, 3-times as many were referred to PCI, resulting in a significant trend for those with the higher risks of restenosis to be preferentially referred to PCI (P=0.015). Similar results were seen when the analysis was restricted to only those with multivessel disease.


CONCLUSIONS
Patients at higher risk for restenosis were being preferentially treated with PCI as opposed to CABG. These results may have implications for reevaluating current patterns of triaging patients between PCI and CABG, and for the use of drug-eluting stents within PCI patients.
Kettelkamp
Richard
R
Mid America Heart Institute, 5th Floor, Saint Luke's Hospital and the University of Missouri-Kansas City, 4100 Wornall Road, Kansas City, MO 64111, USA. kettelkampd@umkc.edu
House
John
J
Garg
Mukesh
M
Stuart
R Scott
RS
Grantham
Aaron
A
Spertus
John
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000517:prevention & control; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D008955:Models, Cardiovascular; D012372:ROC Curve; D012042:Registries; D012306:Risk; D012720:Severity of Illness Index; D015607:Stents; D014218:Triage / Q000379:methods*
D004343:Drug Implants