Abstract 16990: Delayed versus Ad-hoc Percutaneous Coronary Intervention in Multivessel Coronary Artery Disease Patients

Introduction: Cardiac catheterization followed by a delayed percutaneous coronary intervention (PCI) for patients with multivessel coronary artery disease (CAD) allows time for shared decision making and procedural planning. However ad-hoc PCI performed in the same procedure as the diagnostic catheterization, occurs frequently. Whether repeat revascularization is comparable for ad-hoc and delayed PCI patients with multivessel CAD is not well studied. Methods: We identified 8,306 non-emergent PCI patients with multivessel CAD from 2004-2014 from a regional registry of consecutive procedures excluding patients with a recent STEMI and censoring staged procedures. We compared repeat PCI or coronary artery bypass grafting from the registry over 11 years for ad-hoc versus delayed PCI patients. We used Cox’s proportional hazards modeling adjusting for differences in patient characteristics using inverse probability weighting. Results: There were 6,938 (83.5%) ad-hoc and 1,368 (16.5%) delayed PCI patients with a median follow up of 4.8 years. Delayed PCI patients were older, had more comorbidities and more 3 vessel disease (3VD). After adjustment for patient characteristics, ad-hoc PCI patients were not more likely than delayed PCI to undergo repeat revascularization (HR: 1.13, 95%CI: 0.98, 1.30); However, among 1,898 (22.9%) patients with 3VD, ad-hoc PCI was significantly associated with more repeat revascularization than delayed PCI (HR: 1.41, 95%CI: 1.07, 1.85; see figure). There was no difference in adjusted 3VD completeness of revascularization between ad-hoc and delayed PCI (OR: 1.05, 95%CI: 0.92, 1.19). There was no difference in survival between ad-hoc or delayed PCI. Conclusions: While ad-hoc PCI is favored by physicians for efficiency and patients for comfort, it is associated with a higher risk of repeat revascularization than delayed PCI for 3VD patients. These tradeoffs should be carefully considered before proceeding with ad-hoc PCI.