Effect of Cardiac Surgery Availability and Institutional Procedural Volume on Clinical Outcomes Following Complex, High‐Risk, and Indicated Percutaneous Coronary Intervention

作者：W. Zheng, Sara Vogrin, Jiwon Kim, Brendan Backhouse, Diem Dinh, Angela Brennan, Kawa Haji, N. Dayawansa, James Shaw, Derek P. Chew, Jeffrey Lefkovits, Christopher M. Reid, Dion Stub, David M. Kaye, Nicholas J. Cox, William Chan · 发表于：Catheterization and Cardiovascular Interventions · 年份：2025 · DOI：10.1002/ccd.70277 · 被引用次数：1 · 研究领域：Coronary Interventions and Diagnostics、Cardiac and Coronary Surgery Techniques、Acute Myocardial Infarction Research

BACKGROUND: Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) is increasingly performed with variable reported outcomes and consensus on definition. AIMS: We evaluated the relationship between cardiac surgery availability and CHIP-PCI volume (stratified into tertiles < 16, 16‒36, > 36 annual cases) at treating hospitals with 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality. METHODS: All procedures (2014‒2021) captured by a multicenter PCI registry (Victoria, Australia) were analyzed. CHIP-PCI was defined by composite risk score of ≥ 5 points, with prognostic factors assigned three points (e.g., mechanical circulatory support), two points (e.g., age ≥ 80, peripheral vascular disease, severe left ventricular dysfunction, renal impairment) and one point (female, previous stroke, left main/three-vessel PCI, total stent length > 60 mm, rotational atherectomy). RESULTS: Of 91,961 procedures, 6476 (7.0%) were CHIP-PCI (mean age 82 years; 66% females). CHIP-PCI group had high burden of comorbidities including diabetes (26%), renal impairment (93%), and prior coronary bypass surgery (11%). CHIP-PCI was performed for STEMI (21%), non-STEMI (26%) and nonacute coronary syndrome (47%) indications. Overall, 30-day MACCE and 5-year mortality were 13% and 36% respectively. There was no difference in 30-day MACCE and long-term mortality among CHIP-PCI patients treated at cardiac surgical centers versus Nonsurgical centers ...