Drug-eluting stent-supported percutaneous coronary intervention in high risk patients refused cardiac surgery.

AIMS: Randomized trials of drug-eluting stents (DES) have demonstrated their ability to improve clinical outcome in relatively simple lesion/patient subsets. Their potential in patients for whom the risk of coronary bypass grafting is judged prohibitive, remains largely unexplored. To investigate periprocedural and one-year outcome of percutaneous coronary intervention (PCI) using DES in patients refused for coronary artery bypass grafting (CABG).

METHODS AND

RESULTS

At our institution, the therapeutic approach for all patients with multi-vessel disease is decided, by consensus at a conjoint session with the clinical cardiologist, interventionalist and cardiothoracic surgeon enabling unequivocal identification of patients, refused surgery, who were referred for PCI. The EuroSCORE was used to predict peri-operative mortality. From April 2002 to December 2003 we identified 84 such patients. The mean age was 70.9+/-10.1 years and 68% were men. More than one third had prior CABG. Most patients presented with stable or unstable angina pectoris. The reasons for refusal for CABG were: unsuitable coronary anatomy (37%), poor functional status (28%), patent grafts other than the culprit vessel (25%), prior CABG (28%), severe left ventricular dysfunction (13%), co-existing malignancy (18%), prior disabling stroke (12%) and morbid obesity (11%). Using the standard and logistic EuroSCORE methods, the predicted in-hospital mortality rates were 7.8+/-3.3% and 13.2+/-11.1% respectively. In this study, the actual mortality rate was 1.2% at 30 days, 3.6% at 6 months and 4.8% at 1 year follow-up.

CONCLUSIONS

PCI in high risk patients who were refused for CABG in the DES-era resulted in an early and 1-year mortality rate that was significantly lower than the predicted operative mortality.