Introduction There are limited data describing outcomes in patients who have been turned down for surgical revascularisation (CABG) on the basis of prohibitive risk.

Methods We analysed cardiovascular outcomes (composite major adverse clinical event rate, MACE: all cause mortality; cardiac death, myocardial infarction, MI; repeat revascularisation; and stroke) in a retrospective cohort of patients turned down for elective CABG who were treated with PCI or medical therapy in a single centre over a 4 year period.

Results Higher rates of cognitive impairment, chronic total occlusion, peripheral vascular disease (PVD) and atrial fibrillation were seen in the medical treatment group (n = 117). There was no difference between MACE rates in the PCI (n = 131) and medical groups at 30d however a significant difference emerged in MACE at 1 year, 2 year and 3 years due to a reduction in all cause death, cardiac death and MI in the PCI group. There was no difference between MACE rates in the high SYNTAX tertile, unless cases where residual SYNTAX was greater than 22 were excluded from the analysis. Independent predictors of MACE within the PCI group were SYNTAX score and diabetes, whereas peripheral vascular disease, haemodialysis and left main involvement were all associated with negative outcomes in the medical group.

Conclusion Our data suggests a benefit from PCI revascularisation in patients ineligible for surgery at 1 year and a MACE-free survival benefit from PCI up to 3 years in patients within low and intermediate SYNTAX tertiles compared to medical therapy.