Introduction It is well recognised that the prevalence of coronary artery disease and risk of myocardial infarction increases with age. An ageing population and increasing co-morbidity means that the frequency of complex percutaneous coronary intervention (PCI) is increasing.
This is due to:
Surgical turn down for CABG
Improvement in operator technique/equipment
Evidence to support complex percutaneous intervention particularly in the elderly
Methods The total number of PCI procedures performed within the Belfast trust (Belfast City Hospital and Royal Victoria Hospital) between 1st September 2012 and 31st August 2014 were collated from the local database. The indication (elective/ acute coronary syndrome/ST elevation MI) and complexity* of the procedure were recorded along with patient demographics including age, gender, ejection fraction and renal function.
*The procedure was defined as complex if it involved at least one of the following:
PCI of left main stem
Use of high speed rotational atherectomy
Chronic total occlusions
2 consultant operators.
ResultsA total of 5356 PCI procedures were performed.
1209 procedures were complex.
This represents 23% of the total number of procedures performed across the trust.
27% of PCI performed in patients over the age of 80 was complex.
Obviously not all complex PCI performed involved only one criterion
Below is a table showing the percentage breakdown of complex PCI.
PCI for all acute coronary syndromes, Belfast City Hospital
909 procedures had indication as acute coronary syndrome
137 (15%) defined as complex
Of the complex procedures 55 (40%) involved HSRA
PCI for all acute coronary syndromes, Royal Victoria Hospital
1908 procedures had indication as acute coronary syndrome
184 (10%) defined as complex
Of the complex procedures 67 (36%) involved HSRA
PCI for ST elevation MI, Royal Victoria Hospital
Within the ACS cohort:
There were 973 PCI procedures with indication recorded as ST elevation MI
63 (6.5%) procedures were defined as complex
11 (1.3%) procedures involved HSRA
Summary In the Belfast trust over a 2 year period there were 5356 PCI procedures:
Average age was 66; average age complex PCI was 70
12% cases were patients over 80
23% of all cases were defined as complex
27% of cases in over 80s were complex
2817 procedures for ACS (53%)
11% of ACS cases were complex
Routine PCI is becoming increasingly complex with nearly 1 in 4 cases performed in the Belfast trust fulfilling complex criteria.
Over 1 in 10 ACS cases were complex.
Interventionalists should be proficient in HSRA use, invasive imaging modalities such as IVUS/OCT to define anatomy and left main PCI.
Statistics from Altmetric.com
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