C-51 | Evaluation of outcomes of high risk percutaneous coronary intervention in patients with and without prior CABG

The utilization of percutaneous left ventricular assist devices (pLVAD) is increasing among patients undergoing high-risk percutaneous coronary interventions (HR-PCI). It is unclear if prior CABG affects outcomes in such patients. This retrospective study analyzed data from the 2016-2020 Nationwide Inpatient Sample database. We identified patients who underwent HR-PCI with pLVAD. Those with cardiogenic shock were excluded. They were divided into those who had undergone prior CABG and those without. The primary goal was to compare mortality rates between these groups. Multivariate regression analysis was used to exclude confounders. During the study period 18,725 patients underwent HR-PCI procedures with pLVAD support. Among these 2059 (11%) patients had prior CABG. There was no statistically significant difference in the in-hospital mortality among the two groups (5.8% in CABG groups vs 8.5% in non-CABG, p=0.52). Those without prior CABG had higher rates of major bleeding (4.6 vs 8.5%, p=0.007) and AKI (27 vs 36%, p=0.002). There were no significant differences in rates of cardiac arrest, ventricular arrhythmias, acute stroke, coronary dissections, and coronary perforations. Those without prior CABG had longer hospitalization (6.3 vs 9.3 days, p<0.001) and higher hospital charges ($292,267 vs $322,206, p<0.035). Our research underscores that individual without a history of CABG undergoing HR-PCI with LVAD experienced elevated in-hospital complications compared to those with prior CABG. This could be a result of amount of myocardium at jeopardy, collateralization and ischemic preconditioning.