Impact of Surgical Consultation on Outcomes in Hemodynamically Supported High-Risk Percutaneous Coronary Intervention: Insights From PROTECT II Randomized Study.

Background: In observational studies of patients undergoing percutaneous coronary intervention (PCI), surgical ineligibility is associated with increased mortality. Whether the use of hemodynamic support during PCI can mitigate the adverse prognostic importance of surgical ineligibility is unknown.
Methods and Results: We sought to evaluate the association between request for surgical consultation (presumed surgical ineligibility) prior to PCI and clinical outcomes in 427 patients with multivessel coronary artery disease or unprotected left main disease and severely reduced left ventricular systolic function undergoing PCI assisted by hemodynamic support (intraaortic balloon pump or Impella) from the PROTECT II randomized trial. Patients in whom surgical consultation was requested prior to PCI (n = 201) were compared with those in whom surgical consultation was not requested (n = 226). The primary endpoint of this analysis was the composite of 90-day major adverse cardiac and cerebrovascular events (MACCE). Demographic and procedural variables were similar between patients receiving surgical consultation and patients not receiving surgical consultation, with the exception that the prevalence of prior coronary artery bypass graft surgery was significantly higher in patients not receiving surgical consultation (42.0% vs 25.4%; P<.001); these patients also had a higher proportion of lesions within a saphenous vein graft, and a greater prevalence of moderate/severe vessel calcification. MACCE rate at 90 days was similar in patients receiving surgical consultation compared with patients not receiving surgical consultation (23.4% vs 29.0%, respectively; P=.19).
Conclusions: In this high-risk cohort of patients undergoing hemodynamically supported PCI, clinical outcome was not associated with an antecedent request for surgical consultation (presumed surgical ineligibility). Whether the use of hemodynamically supported PCI can lessen the risk conferred by surgical ineligibility requires further study.