title: Impact of Surgical Consultation on Outcomes in Hemodynamically Supported High-Risk Percutaneous Coronary Intervention: Insights From PROTECT II Randomized Study.
abstract: BACKGROUND
  In observational studies of patients undergoing percutaneous coronary intervention (PCI), surgical ineligibility is associated with increased mortality. Whether the use of hemodynamic support during PCI can mitigate the adverse prognostic importance of surgical ineligibility is unknown.
  
  
  RESULTS
  We sought to evaluate the association between request for surgical consultation (presumed surgical ineligibility) prior to PCI and clinical outcomes in 427 patients with multivessel coronary artery disease or unprotected left main disease and severely reduced left ventricular systolic function undergoing PCI assisted by hemodynamic support (intraaortic balloon pump or Impella) from the PROTECT II randomized trial. Patients in whom surgical consultation was requested prior to PCI (n = 201) were compared with those in whom surgical consultation was not requested (n = 226). The primary endpoint of this analysis was the composite of 90-day major adverse cardiac and cerebrovascular events (MACCE). Demographic and procedural variables were similar between patients receiving surgical consultation and patients not receiving surgical consultation, with the exception that the prevalence of prior coronary artery bypass graft surgery was significantly higher in patients not receiving surgical consultation (42.0% vs 25.4%; P<.001); these patients also had a higher proportion of lesions within a saphenous vein graft, and a greater prevalence of moderate/severe vessel calcification. MACCE rate at 90 days was similar in patients receiving surgical consultation compared with patients not receiving surgical consultation (23.4% vs 29.0%, respectively; P=.19).
  
  
  CONCLUSIONS
  In this high-risk cohort of patients undergoing hemodynamically supported PCI, clinical outcome was not associated with an antecedent request for surgical consultation (presumed surgical ineligibility). Whether the use of hemodynamically supported PCI can lessen the risk conferred by surgical ineligibility requires further study.
authors.affiliation: Division of Cardiovascular Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033 USA. shavelle@usc.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Shavelle
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Theodore L
authors.initials: TL
authors.lastname: Schreiber
authors.forename: Neel K
authors.initials: NK
authors.lastname: Kapasi
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Popma
authors.forename: Ray V
authors.initials: RV
authors.lastname: Matthews
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D013997:Time Factors