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

Abstract

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-ReVasc Registry (ReVR). 30-day major cardiovascular event outcomes were collected. Findings in ReVR patients were directly compared to reference PCI and isolated CABG pre-COVID-19 data from British Cardiovascular Intervention Society (BCIS) and National 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 left anterior descending artery involvement (94.8% vs 67.2%, P <.001) compared to BCIS data. 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 calcium modification (23.6% vs 3.5%, P <.001) was observed. No difference in in-hospital mortality was demonstrated compared to PCI and CABG data (ReVR 1.4% vs BCIS 0.7%, P =.19; vs NCAP 1.0%, P =.48). Inpatient stay was half compared to CABG (3.0 vs 6.0 days). Low-event rates in ReVR were maintained to 30-day follow-up. 

Conclusions: PCI undertaken using contemporary techniques produces excellent short-term results in patients who would be otherwise CABG candidates. Longer-term follow-up is essential to determine whether these outcomes are maintained over time.

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