title: Clinical outcomes of percutaneous coronary intervention in patients turned down for surgical revascularization.
abstract: OBJECTIVE
  We examined clinical outcomes following percutaneous coronary intervention (PCI) in patients turned down for surgical revascularization across a broad population.
  
  
  BACKGROUND
  Prior studies suggest that surgical ineligibility is associated with increased mortality in patients with unprotected left main or multivessel coronary artery disease undergoing PCI.
  
  
  METHODS
  This study included consecutive patients who underwent PCI in a multicenter registry in Michigan from January 2010 to December 2014. Surgical ineligibility required documentation indicating that a cardiac surgeon deemed the patient ineligible for surgery. In-hospital outcomes included mortality (primary outcome), cardiogenic shock, cerebrovascular accident, contrast-induced nephropathy (CIN), and a new requirement for dialysis (NRD).
  
  
  RESULTS
  Of 99,370 patients at 33 hospitals with on-site surgical backup, 1,922 (1.9%) were surgically ineligible. The rate of ineligibility did not vary by hospital (range: 1.5-2.5%; P = 0.79). Overall, there were no major differences in baseline characteristics or outcomes between surgically ineligible patients and the rest (i.e., nonineligible patients): mortality (0.52% vs. 0.52%; P > 0.5), cardiogenic shock (0.68% vs. 0.73%; P > 0.5), cerebrovascular accident (0.05% vs. 0.19%; P = 0.28), NRD (0.16% vs. 0.19%; P > 0.5), CIN (2.7% vs. 2.3%; P = 0.27). Among 1,074 patients who underwent unprotected left main PCI, 20 (1.9%) were surgically ineligible and experienced increased rates of mortality (20.0% vs. 5.3%; P = 0.022; adjusted OR = 7.38; P < 0.001) and other complications as compared to the remainder.
  
  
  CONCLUSIONS
  PCI in a broad population of surgically ineligible patients is generally safe. However, among patients who underwent unprotected left main PCI, those deemed surgically ineligible experienced significantly worse outcomes as compared to the rest. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Devraj
authors.initials: D
authors.lastname: Sukul
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.affiliation: Division of Cardiology, Department of Medicine, Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Dixon
authors.affiliation: McLaren Macomb Hospital, Roseville, Michigan.
authors.forename: Mark
authors.initials: M
authors.lastname: Zainea
authors.affiliation: Traverse Heart and Vascular, Traverse City, Michigan.
authors.forename: Nicklaus K
authors.initials: NK
authors.lastname: Slocum
authors.affiliation: Michigan Heart, St Joseph Mercy Health System, Jackson, Michigan.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Pielsticker
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.|Veterans Affairs Medical Center, Ann Arbor, Michigan.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D003287:Contrast Media / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004608:Eligibility Determination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000628:therapy; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D061214:Patient Safety; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: coronary artery bypass grafting; coronary artery disease; health care outcomes; percutaneous coronary intervention (PCI); risk stratification