Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?

Abstract

Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.

Keywords: CHIP; complex PCI; hemodynamic support devices; high risk; multivessel disease; surgical ineligible; surgical turndown.

Figure 1

Complex high-risk indicated procedures definition and benefits. COPD, Chronic obstructive pulmonary disease; LV, left ventricle; LVEDP, left ventricular end-diastolic pressure; PCI, Percutaneous coronary intervention.