Outcomes following PCI in CABG candidates during the COVID-19 pandemic: The prospective multicentre UK-ReVasc registry

Objectives:To describe outcomes following percutaneous coronary intervention (PCI)in patients who would usually have undergone coronary artery bypass grafting (CABG).Background:In the United Kingdom, cardiac surgery for coronary artery disease(CAD) was dramatically reduced during the first wave of the COVID-19 pandemic.Many patients with“surgical disease”instead underwent PCI.Methods:Between 1 March 2020 and 31 July 2020, 215 patients with recognized“surgical”CAD who underwent PCI were enrolled in the prospective UK-ReVascRegistry (ReVR). 30-day major cardiovascular event outcomes were collected. Find-ings in ReVR patients were directly compared to reference PCI and isolated CABGpre-COVID-19 data from British Cardiovascular Intervention Society (BCIS) andNational Cardiac Audit Programme (NCAP) databases.Results:ReVR patients had higher incidence of diabetes (34.4% vs 26.4%,P=.008),multi-vessel disease with left main stem disease (51.4% vs 3.0%,P< .001) and leftanterior descending artery involvement (94.8% vs 67.2%,P< .001) compared to BCISdata. SYNTAX Score in ReVR was high (mean 28.0). Increased use of transradial access(93.3% vs 88.6%,P= .03), intracoronary imaging (43.6% vs 14.4%,P< .001) and cal-cium modification (23.6% vs 3.5%,P< .001) was observed. No difference in in-hospitalmortality was demonstrated compared to PCI and CABG data (ReVR 1.4% vs BCIS0.7%,P= .19; vs NCAP 1.0%,P= .48). Inpatient stay was half compared to CABG (3.0vs 6.0 days). Low-event rates in ReVR were maintained to 30-day follow-up.Conclusions:PCI undertaken using contemporary techniques produces excellentshort-term results in patients who would be otherwise CABG candidates. Longer-termfollow-up is essential to determine whether these outcomes are maintained over time.