Incidence of cardiac surgery following PCI: Insights from a high volume, non-surgical, UK centre
Whittaker A., Green P., Coverdale G., Rana O., Levy T.
Copyright Medinews (Cardiology) Limited. Percutaneous coronary intervention (PCI) has established itself as an effective alternative to coronary artery bypass graft surgery (CABG) in appropriate patients. However, the proportion of patients that undergo CABG and/or valve surgery (VS) following PCI in the short and long term is currently unknown. We conducted a single-centre, retrospective study examining the indications and number of patients requiring CABG and or VS following successful PCI between 2009 and 2012. The surgical procedure was categorised as early (referred within <1 month of the index PCI), mid-term (referred 1-12 months after index PCI) and remote (referred >1 year and up to four years following the index PCI). During each three-year period (2008-2010, 2009-2011), 5,244 PCIs were performed at our centre. The total number of patients referred for cardiac surgery post-PCI was 63 (1.2%). The number of patients referred for early, mid-term and remote cardiac surgery was 21 (0.4%), 14 (0.26%) and 28 (0.53%), respectively. Within the early group, eight patients had extensive three- vessel disease stabilised with emergency/ urgent PCI to allow subsequent CABG, while 10 patients had failed PCI to a chronic total occlusion. In the mid-term group, the main reason for surgery was rapid progression in coronary disease. In the remote group, the majority of patients underwent surgery for progression of valve disease. Our data suggest that the number of patients requiring CABG and/or VS following PCI is small, and the indications differ with time following the index PCI. We hope that these results will provide reassurance and interest to our interventional colleagues.