Trends and Real-World Safety of Patients Undergoing Percutaneous Coronary Intervention for Symptomatic Stable Ischaemic Heart Disease in Australia

Garry W. Hamilton, Julian Yeoh, Diem Dinh, Christopher M. Reid, Matias B. Yudi, Melanie Freeman, Angela Brennan, Dion Stub, Ernesto Oqueli, Martin Sebastian, Stephen J. Duffy, Mark Horrigan, Omar Farouque, Andrew Ajani, David J. Clark, on behalf of the Melbourne Interventional Group Registry

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Percutaneous coronary intervention (PCI) in stable ischaemic heart disease (SIHD) has not been shown to improve prognosis but can alleviate symptoms and improve quality of life. Appropriately selected patients with symptoms refractory to medical therapy therefore stand to benefit, provided safety is proven. Methods: Consecutive patients undergoing PCI for SIHD between 2005–2018 in a prospective registry were included. Yearly comparisons evaluated trends, and a sub-analysis was performed comparing proximal left anterior descending (LAD) (prox-LAD) to other-than-proximal LAD (non-pLAD) PCI. Outcomes included peri-procedural characteristics, in-hospital and 30-day outcomes including MACE, and 5-year National Death Index (NDI) linked mortality. Results: There were 9,421 procedures included. Over time, patients were increasingly co-morbid and had higher rates of AHA/ACC class B2/C lesions, ostial stenoses, bifurcation lesions, and chroncic total occlusions (all p-for-trend ≤0.001). Over 14 years, in hospital major bleeding reduced (1.05% in 2006/07 vs 0.29% in 2017/18, p-for-trend <0.001). Other in-hospital and 30-day outcomes were stably low. There were only seven (0.07%) in hospital deaths and 5-year mortality was 10.3%. No differences were found in outcomes between patients who underwent prox-LAD compared to non-pLAD PCI. Independent predictors of NDI linked all-cause mortality included an eGFR <30 mL/min/1.73 m2 (HR 4.06, 95% CI 3.26–5.06), COPD (HR 2.25, 95% CI 1.89–2.67) and LVEF <30% (HR 2.13, 95% CI 1.57–2.89). Conclusions: These real-world data provide insights to enhance shared decision making regarding whether PCI should be pursued in patients with symptomatic SIHD refractory to medical therapy.

Original languageEnglish
Pages (from-to)1619-1629
Number of pages11
JournalHeart Lung and Circulation
Volume31
Issue number12
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Outcomes
  • Percutaneous coronary intervention
  • Real-world
  • Safety
  • Stable ischaemic heart disease

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