Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery

Laura Hanson; Sara Vogrin; Samer Noaman; Diem Dinh; Wayne Zheng; Jeffrey Lefkovits; Angela Brennan; Christopher Reid; Dion Stub; Stephen J. Duffy; Jamie Layland; Melanie Freeman; William van Gaal; Nicholas Cox; William Chan; on behalf of the Victorian Cardiac Outcomes Registry Investigators

doi:10.1016/j.amjcard.2021.12.051

Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery

Laura Hanson, Sara Vogrin, Samer Noaman, Diem Dinh, Wayne Zheng, Jeffrey Lefkovits, Angela Brennan, Christopher Reid, Dion Stub, Stephen J. Duffy, Jamie Layland, Melanie Freeman, William van Gaal, Nicholas Cox, William Chan, on behalf of the Victorian Cardiac Outcomes Registry Investigators

Research output: Contribution to journal › Article › Research › peer-review

6 Citations (Scopus)

Abstract

Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.

Original language	English
Pages (from-to)	39-46
Number of pages	8
Journal	The American Journal of Cardiology
Volume	168
DOIs	https://doi.org/10.1016/j.amjcard.2021.12.051
Publication status	Published - 1 Apr 2022

Access to Document

10.1016/j.amjcard.2021.12.051

Cite this

Hanson, L., Vogrin, S., Noaman, S., Dinh, D., Zheng, W., Lefkovits, J., Brennan, A., Reid, C., Stub, D., Duffy, S. J., Layland, J., Freeman, M., van Gaal, W., Cox, N., Chan, W., & on behalf of the Victorian Cardiac Outcomes Registry Investigators (2022). Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery. The American Journal of Cardiology, 168, 39-46. https://doi.org/10.1016/j.amjcard.2021.12.051

@article{6b1e4e181fc84215a5a0560fbe045f81,

title = "Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery",

abstract = "Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81\%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35\% vs 16\%) and cardiogenic shock (25\% vs 15\%), with higher rates of preprocedural intubation (17\% vs 11\%) and mechanical circulatory support (20\% vs 9.3\%), all p <0.01. Unadjusted in-hospital mortality (23\% vs 11.4\%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26\% vs 16\%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95\% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95\% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95\% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95\% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.",

author = "Laura Hanson and Sara Vogrin and Samer Noaman and Diem Dinh and Wayne Zheng and Jeffrey Lefkovits and Angela Brennan and Christopher Reid and Dion Stub and Duffy, \{Stephen J.\} and Jamie Layland and Melanie Freeman and \{van Gaal\}, William and Nicholas Cox and William Chan and \{on behalf of the Victorian Cardiac Outcomes Registry Investigators\}",

note = "Funding Information: A/Prof Stub's work is supported by National Heart foundation fellowship, GNT 101908. Prof. Duffy's work is supported by a National Health and Medical Research Council of Australia (Canberra, Australia) ], GNT 1111170. Prof. Reid's work is supported by mixed National Health and Medical Research Council (Canberra, Australia) Principal Research Fellowship, GNT 1136372. Funding Information: We analyzed data from consecutive patients who underwent unprotected LM PCI who were prospectively enrolled in the Victorian Cardiac Outcomes Registry between January 2014 and December 2018. The Victorian Cardiac Outcomes Registry is a state-wide population-based, all-comers registry, established to record the performance of PCI and improve the quality of care in cardiovascular disease in Victoria, Australia. 18 , 19 Details of the 30 hospitals (13 public and 17 private) involved in the Victorian Cardiac Outcomes Registry are provided in the Supplementary Appendix ( Supplementary Table 1 ). The Victorian Cardiac Outcomes Registry records baseline demographic and procedural characteristics and in-hospital and 30-day outcome data on all patients who underwent PCI through a secure web-based data collection system. It is coordinated by Monash University in conjunction with the Victorian Cardiac Clinical Network and is funded by the Victorian Department of Health and Human Services. 18 In the PCI module, the registry is approved by the ethics committee at each participating hospital. All patients who underwent PCI are included in the registry unless the patient “opts out.” 18 , 19 Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2022",

month = apr,

day = "1",

doi = "10.1016/j.amjcard.2021.12.051",

language = "English",

volume = "168",

pages = "39--46",

journal = "The American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier",

}

Hanson, L, Vogrin, S, Noaman, S, Dinh, D, Zheng, W, Lefkovits, J, Brennan, A, Reid, C , Stub, D, Duffy, SJ, Layland, J, Freeman, M, van Gaal, W, Cox, N, Chan, W & on behalf of the Victorian Cardiac Outcomes Registry Investigators 2022, 'Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery', The American Journal of Cardiology, vol. 168, pp. 39-46. https://doi.org/10.1016/j.amjcard.2021.12.051

TY - JOUR

T1 - Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery

AU - Hanson, Laura

AU - Vogrin, Sara

AU - Noaman, Samer

AU - Dinh, Diem

AU - Zheng, Wayne

AU - Lefkovits, Jeffrey

AU - Brennan, Angela

AU - Reid, Christopher

AU - Stub, Dion

AU - Duffy, Stephen J.

AU - Layland, Jamie

AU - Freeman, Melanie

AU - van Gaal, William

AU - Cox, Nicholas

AU - Chan, William

AU - on behalf of the Victorian Cardiac Outcomes Registry Investigators

N1 - Funding Information: A/Prof Stub's work is supported by National Heart foundation fellowship, GNT 101908. Prof. Duffy's work is supported by a National Health and Medical Research Council of Australia (Canberra, Australia) ], GNT 1111170. Prof. Reid's work is supported by mixed National Health and Medical Research Council (Canberra, Australia) Principal Research Fellowship, GNT 1136372. Funding Information: We analyzed data from consecutive patients who underwent unprotected LM PCI who were prospectively enrolled in the Victorian Cardiac Outcomes Registry between January 2014 and December 2018. The Victorian Cardiac Outcomes Registry is a state-wide population-based, all-comers registry, established to record the performance of PCI and improve the quality of care in cardiovascular disease in Victoria, Australia. 18 , 19 Details of the 30 hospitals (13 public and 17 private) involved in the Victorian Cardiac Outcomes Registry are provided in the Supplementary Appendix ( Supplementary Table 1 ). The Victorian Cardiac Outcomes Registry records baseline demographic and procedural characteristics and in-hospital and 30-day outcome data on all patients who underwent PCI through a secure web-based data collection system. It is coordinated by Monash University in conjunction with the Victorian Cardiac Clinical Network and is funded by the Victorian Department of Health and Human Services. 18 In the PCI module, the registry is approved by the ethics committee at each participating hospital. All patients who underwent PCI are included in the registry unless the patient “opts out.” 18 , 19 Publisher Copyright: © 2021 Elsevier Inc.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.

AB - Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.

UR - https://www.scopus.com/pages/publications/85123850161

U2 - 10.1016/j.amjcard.2021.12.051

DO - 10.1016/j.amjcard.2021.12.051

M3 - Article

C2 - 35115134

AN - SCOPUS:85123850161

SN - 0002-9149

VL - 168

SP - 39

EP - 46

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

ER -

Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery

Abstract

Access to Document

Other files and links

Characterization and optimization of post cardiac arrest care with multi-modality imaging, cardiac intervention and novel therapeutics

Detailed examination of the linked Victorian Admitted Episodes Dataset (VAED)/Victorian Emergency Minimum Dataset (VEMD) and the Victorian Cardiac Outcomes Registry (VCOR)

Advanced analyses of the Melbourne Interventional Group (MIG) percutaneous coronary intervention (PCI) registry data

Cite this

Long-Term Outcomes of Unprotected Left Main Percutaneous Coronary Intervention in Centers Without Onsite Cardiac Surgery

Abstract

Access to Document

Other files and links

Projects

Characterization and optimization of post cardiac arrest care with multi-modality imaging, cardiac intervention and novel therapeutics

Detailed examination of the linked Victorian Admitted Episodes Dataset (VAED)/Victorian Emergency Minimum Dataset (VEMD) and the Victorian Cardiac Outcomes Registry (VCOR)

Advanced analyses of the Melbourne Interventional Group (MIG) percutaneous coronary intervention (PCI) registry data

Cite this