C-47 | Evaluating Patient Eligibility for Percutaneous Coronary Intervention (PCI) by ISCHEMIA, COURAGE and REVIVED-BCIS2 Trial Standards

In the pursuit of advancing invasive cardiovascular care and refining patient selection for percutaneous coronary intervention (PCI), our institution conducted a comprehensive analysis of patients who underwent PCI. The results of this investigation offer a revealing glimpse into the eligibility landscape for intervention in our community hospital based patient cohort, shedding light on the alignment, or lack thereof, with the selection criteria described in landmark trials. All patients who received coronary interventions (N=251) at our institution over a 3 month period were compared to the inclusion and exclusion criteria of the COURAGE, ISCHEMIA, and REVIVED-BCIS2 trials. The mean patient age was 66.57 [± 11.23] years with a median age of 66 years and age range of 32 to 94 years. 78% of patients were male with mean BMI of 30.28 [± 6.54] kg/m2. Compared to the COURAGE trial cohort, 80.07% of our patients met exclusion criteria. Compared to the ISCHEMIA trial cohort, 84.46% of our patients met exclusion criteria. Compared to the REVIVED-BCIS2 trial cohort, only 17.13% of our patients would have met inclusion criteria, of which 46.51% of those patients would have met at least 1 exclusion criteria. The majority of our patients would have been excluded from these trials due to acute coronary syndromes (STEMI, NSTEMI, UA) [59%] or uncontrolled angina [49.4%] despite treatment with at least two antianginal agents. Trial environments cannot always be extrapolated to real world clinical practice. Local expertise and the heart team approach is critical for patient centered care. This exploration not only contributes to the ongoing discourse in cardiovascular medicine but also prompts critical reflections on the practical applicability of trial-derived guidelines in real-world patient populations. Although these landmark trials focus on stable ischemic heart disease, the majority of patients receiving PCI at our institution are not stable and would not qualify for prolonged conservative therapies.