Surgical Ineligibility and Long-Term Outcomes in Patients With Severe Coronary Artery Disease

Background:In patients with severe coronary artery disease (CAD) requiring coronary revascularization, the prevalence of surgical ineligibility and its clinical effect on long-term outcomes remain unclear.Methods and Results:Among 15,939 patients with first coronary revascularization in the CREDO-Ky...

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Published in:Circulation Journal 2019/09/25, Vol.83(10), pp.2061-2069
Main Authors: Matsumura-Nakano, Yukiko, Shiomi, Hiroki, Morimoto, Takeshi, Furukawa, Yutaka, Nakagawa, Yoshihisa, Kadota, Kazushige, Ando, Kenji, Yamaji, Kyohei, Shizuta, Satoshi, Sakata, Ryuzo, Hanyu, Michiya, Shimamoto, Mitsuomi, Komiya, Tatsuhiko, Kimura, Takeshi, on behalf of the CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cause of Death
Contraindications, Procedure
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - mortality
Coronary artery bypass grafting
Coronary artery disease
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - mortality
Coronary Artery Disease - therapy
Disease Progression
Eligibility Determination
Female
Humans
Japan
Male
Middle Aged
Myocardial Infarction - mortality
Percutaneous coronary intervention
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - mortality
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke - mortality
Surgical ineligibility
Time Factors
Treatment Outcome
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Summary:Background:In patients with severe coronary artery disease (CAD) requiring coronary revascularization, the prevalence of surgical ineligibility and its clinical effect on long-term outcomes remain unclear.Methods and Results:Among 15,939 patients with first coronary revascularization in the CREDO-Kyoto percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry cohort-2, we identified 3,982 patients with triple-vessel or left main disease (PCI: n=2,188, and CABG: n=1,794). Surgical ineligibility as documented in hospital charts was present in 142 (6.5%) of 2,188 PCI-patients, which was mainly related to comorbidities and advanced age. The cumulative 5-year incidence of the primary outcome measure (all-cause death/myocardial infarction/stroke) was much higher in PCI-patients with surgical ineligibility than in PCI-patients without surgical ineligibility and in CABG-patients (52.5%, 27.6%, and 24.0%, respectively, log-rank P
ISSN:1346-9843
1347-4820
1347-4820
DOI:10.1253/circj.CJ-19-0440