Outcomes following PCI in CABG candidates during the COVID-19 pandemic: The prospective multicentre UK-ReVasc registry

Objectives:To describe outcomes following percutaneous coronary intervention (PCI)in patients who would usually have undergone coronary artery bypass grafting (CABG).Background:In the United Kingdom, cardiac surgery for coronary artery disease(CAD) was dramatically reduced during the first wave of the COVID-19 pandemic.Many patients with“surgical disease”instead underwent PCI.Methods:Between 1 March 2020 and 31 July 2020, 215 patients with recognized“surgical”CAD who underwent PCI were enrolled in the prospective UK-ReVascRegistry (ReVR). 30-day major cardiovascular event outcomes were collected. Find-ings in ReVR patients were directly compared to reference PCI and isolated CABGpre-COVID-19 data from British Cardiovascular Intervention Society (BCIS) andNational Cardiac Audit Programme (NCAP) databases.Results:ReVR patients had higher incidence of diabetes (34.4% vs 26.4%,P=.008),multi-vessel disease with left main stem disease (51.4% vs 3.0%,P< .001) and leftanterior descending artery involvement (94.8% vs 67.2%,P< .001) compared to BCISdata. SYNTAX Score in ReVR was high (mean 28.0). Increased use of transradial access(93.3% vs 88.6%,P= .03), intracoronary imaging (43.6% vs 14.4%,P< .001) and cal-cium modification (23.6% vs 3.5%,P< .001) was observed. No difference in in-hospitalmortality was demonstrated compared to PCI and CABG data (ReVR 1.4% vs BCIS0.7%,P= .19; vs NCAP 1.0%,P= .48). Inpatient stay was half compared to CABG (3.0vs 6.0 days). Low-event rates in ReVR were maintained to 30-day follow-up.Conclusions:PCI undertaken using contemporary techniques produces excellentshort-term results in patients who would be otherwise CABG candidates. Longer-termfollow-up is essential to determine whether these outcomes are maintained over time.</p

A Placebo-Controlled Trial of Percutaneous Coronary Intervention for Stable Angina

Background: Percutaneous coronary intervention (PCI) is frequently performed to reduce the symptoms of stable angina. Whether PCI relieves angina more than a placebo procedure in patients who are not receiving antianginal medication remains unknown. Methods: We conducted a double-blind, randomized, placebo-controlled trial of PCI in patients with stable angina. Patients stopped all antianginal medications and underwent a 2-week symptom assessment phase before randomization. Patients were then randomly assigned in a 1:1 ratio to undergo PCI or a placebo procedure and were followed for 12 weeks. The primary end point was the angina symptom score, which was calculated daily on the basis of the number of angina episodes that occurred on a given day, the number of antianginal medications prescribed on that day, and clinical events, including the occurrence of unblinding owing to unacceptable angina or acute coronary syndrome or death. Scores range from 0 to 79, with higher scores indicating worse health status with respect to angina. Results: A total of 301 patients underwent randomization: 151 to the PCI group and 150 to the placebo group. The mean (±SD) age was 64±9 years, and 79% were men. Ischemia was present in one cardiac territory in 242 patients (80%), in two territories in 52 patients (17%), and in three territories in 7 patients (2%). In the target vessels, the median fractional flow reserve was 0.63 (interquartile range, 0.49 to 0.75), and the median instantaneous wave-free ratio was 0.78 (interquartile range, 0.55 to 0.87). At the 12-week follow-up, the mean angina symptom score was 2.9 in the PCI group and 5.6 in the placebo group (odds ratio, 2.21; 95% confidence interval, 1.41 to 3.47; P<0.001). One patient in the placebo group had unacceptable angina leading to unblinding. Acute coronary syndromes occurred in 4 patients in the PCI group and in 6 patients in the placebo group. Conclusions: Among patients with stable angina who were receiving little or no antianginal medication and had objective evidence of ischemia, PCI resulted in a lower angina symptom score than a placebo procedure, indicating a better health status with respect to angina. (Funded by the National Institute for Health and Care Research Imperial Biomedical Research Centre and others.</p