Key result
Treatment at cardiac surgical centers and higher institutional CHIP-PCI volume were not associated with differences in 30-day MACCE or long-term mortality (all p > 0.05).
Why the study?
CHIP-PCI is increasingly performed, but reported clinical outcomes vary and consensus on its definition is lacking.
Does on-site cardiac surgery availability or higher institutional procedural volume improve 30-day MACCE and long-term mortality in patients undergoing CHIP-PCI?
Observational (n=6,476)
Yes
Does on-site cardiac surgery availability or higher institutional procedural volume improve 30-day MACCE and long-term mortality in patients undergoing CHIP-PCI?
No association of center type or volume with CHIP-PCI outcomes; leaves open optimal site selection for these procedures.
BACKGROUND: Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) is increasingly performed with variable reported outcomes and consensus on definition. AIMS: We evaluated the relationship between cardiac surgery availability and CHIP-PCI volume (stratified into tertiles < 16, 16‒36, > 36 annual cases) at treating hospitals with 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality. METHODS: All procedures (2014‒2021) captured by a multicenter PCI registry (Victoria, Australia) were analyzed. CHIP-PCI was defined by composite risk score of ≥ 5 points, with prognostic factors assigned three points (e.g., mechanical circulatory support), two points (e.g., age ≥ 80, peripheral vascular disease, severe left ventricular dysfunction, renal impairment) and one point (female, previous stroke, left main/three-vessel PCI, total stent length > 60 mm, rotational atherectomy). RESULTS: Of 91,961 procedures, 6476 (7.0%) were CHIP-PCI (mean age 82 years; 66% females). CHIP-PCI group had high burden of comorbidities including diabetes (26%), renal impairment (93%), and prior coronary bypass surgery (11%). CHIP-PCI was performed for STEMI (21%), non-STEMI (26%) and nonacute coronary syndrome (47%) indications. Overall, 30-day MACCE and 5-year mortality were 13% and 36% respectively. There was no difference in 30-day MACCE and long-term mortality among CHIP-PCI patients treated at cardiac surgical centers versus Nonsurgical centers (all p > 0.05). Likewise, there was no association between tertiles of annual CHIP-PCI volume with 30-day MACCE and long-term mortality (all p > 0.05). CONCLUSIONS: In contemporary practice, CHIP-PCI outcomes appear similar across institutional CHIP-PCI volume tertiles and availability of cardiac surgery. High rates of adverse outcomes underscore the need for further research regarding revascularization appropriateness.
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Zheng et al. (2025) conducted an observational in Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) (n=6,476). Cardiac surgery availability and institutional CHIP-PCI volume vs. Nonsurgical centers and lower volume tertiles was evaluated on 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality (p=> 0.05). Treatment at cardiac surgical centers and higher institutional CHIP-PCI volume were not associated with differences in 30-day MACCE or long-term mortality (all p > 0.05).
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