Background: Coronary artery disease is a cardiovascular condi3on that has been iden3fied as the leading cause of death worldwide. Today, the first-line treatment is percutaneous revasculariza3on (also known as percutaneous coronary interven3on, PCI). Among the pa3ents concerned, there are complex, high-risk cases that require a specific approach to ensure op3mal results. Technological advances in PCI have enabled to treat complex pa3ents with a high surgical risk but a strong indica3on for revasculariza3on called CHIP interven3ons (complex high-risk but indicated percutaneous interven3ons). Pa3ent risk includes three interrelated domains, each contribu3ng to the overall risk profile: the anatomical complexity of coronary lesions, pa3ents' risk factors and comorbidi3es and the adverse hemodynamic status of the pa3ents.
Methodology: Retrospec3ve analysis using anonymized data obtained from the Cardiac Catheteriza3on Laboratory at CHUV (Centre Hospitalier Universitaire Vaudois). The study focused on pa3ents who underwent CHIP interven3ons at CHUV between 2019 and 2022, comprising a total of 306 pa3ents. The study subdivided the CHIP popula3on into four dis3nct subgroups: LeT Main Disease (Group 1), Chronic Total Occlusion (CTO, Group 2), High calcified lesions (HCL, Group 3), Hemodynamic Support ECMO/Impella (Group 4). The primary objec3ve was to assess intra-hospital mortality rates in pa3ents undergoing CHIP interven3ons. Secondary objec3ves included evalua3ng complica3ons such as deaths, myocardial infarc3on (MI), stroke, and secondary bleeding associated with the interven3ons.
Results: 306 pa3ents (65.52% of the total) underwent CHIP procedures for stable coronary artery disease at CHUV, Lausanne, Switzerland, from January 1, 2019, to December 31, 2022. Pa3ents were primarily categorized into four groups: CTO (49.3%), LMD (26.5%), High calcified lesions (16.3%), and ECMO/Impella (7.8%). Men were more prevalent in each category. Hypertension and dyslipidemia were the predominant cardiovascular risk factors across all groups, with hypertension most prevalent in the LMD, HCL, and ECMO/Impella groups, while dyslipidemia was most common in the CTO group. Total intra-hospital mortality was 4.6%, with ECMO/Impella pa3ents experiencing the highest mortality rate (41.7%). Mortality rates for other groups were 3.7% for LMD, 2% for CTO, and no deaths in the HCL group.
Complica3ons included myocardial infarc3on, stroke, and secondary bleeding, with higher rates in the ECMO/Impella group (4.2%, 8.3%, and 4.2%, respec3vely). Over four years, the number of CHIP interven3ons decreased, with a 22.7% decrease between 2019 and 2020.
Conclusion: This study aligns with exis3ng literature in terms of clinical outcomes. CTO procedures were most common, and leT main procedures demonstrated safety, with non- cardiac factors contribu3ng to mortality. Lower mortality rates were observed for HCL and CTO procedures, while the ECMO/Impella group exhibited the highest mortality. This underscores the need for circulatory hemodynamic support in cri3cally ill pa3ents, with poten3al for improved pa3ent selec3on through ongoing research.