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Objectives In this study we evaluated the clinical characteristics and outcomes of surgically ineligible patients with coronary artery disease (CAD) who underwent multivessel percutaneous coronary intervention (PCI). Background Patients with multivessel CAD who are surgically ineligible and undergo PCI are not well represented in large trials. Methods Out of 1,061 consecutive patients who underwent a non-emergent PCI for unprotected left main or multivessel CAD at the University of Virginia Medical Center, 137 patients were determined to be surgically ineligible for coronary artery bypass graft (CABG) surgery by a heart team. The clinical characteristics and reasons for surgical ineligibility were collected. The coronary angiograms were reviewed and the SYNTAX score calculated. The Society of Thoracic Surgeons (STS) score was calculated. Outcomes were determined at 30 days and 1-year. Results The mean age of the cohort was 71 and 59% were women. Hypertension, hyperlipidemia, tobacco abuse, and diabetes were common comorbidities. The average SYNTAX score was 22. The most commonly cited reasons for surgical ineligibility were advanced age, frailty, severe lung disease, ejection fraction ≤ 30% and STS score ≥ 8%. Outcomes at 30 days were excellent and better than those predicted by STS for surgery. Frailty and STS score predicted one-year outcomes. Conclusions Patients undergoing PCI for multivessel disease who are surgically ineligible have multiple risk factors and comorbidities. Frailty, lung disease, poor left ventricular function, and high STS score represent common reasons for surgical ineligibility. Frailty and the STS score better predict one-year outcomes after PCI compared to the SYNTAX score.

Circulating fibrocytes are a population of bone marrow-derived progenitor cells that have been implicated in neovascularization. The recruitment of coronary artery collaterals, a form of neovascularization, is associated with improved outcomes in coronary artery disease. In this study, we tested the hypothesis that, in subjects with stable chronic coronary artery disease, the blood concentration of fibrocytes is associated with the presence of angiographic coronary collaterals. A total of 58 subjects with at least one epicardial coronary artery with ≥ 90% luminal stenosis were enrolled, among whom 26 (45%) had angiographic evidence of coronary collaterals. Subjects with collaterals had significantly elevated circulating concentrations of all examined subsets of activated fibrocytes, suggesting that there is a relationship between fibrocytes and coronary collateral recruitment.