Title : Experience of complex high risk PCI cases in tertiary level referral center in north India: Its time to look beyond Syntax score
According to recent guidelines, Syntax score up to 22 PCI is preferable over CABG while for syntax score >22 CABG is preferred. Syntax score should not be the sole criterion of appropriateness of PCI success. Other clinical features like age, renal function, ejection fraction, degree of MR, presence of mechanical complications also need to be taken into account. It is not possible for CHIP cases to be randomized in any clinical trial because of the clinical scenario and multiple co-morbidities .As there is high risk of death on table in these cases, these are often rejected by cardiac surgeons. Importantly, it is not necessary to perform PCI in CHIP cases in a single stage. Goal is adequately and functionally complete myocardial revascularization. As no 2 CHIP cases are alike, guidelines can never dictate approach for these cases. PCI [may be in stages] performed judiciously is a safer and viable alternative to CABG. In SMS Medical College Jaipur, we have been regularly performing CHIP cases refused by surgeons. In a series of 48 patients with CAD with severe LV dysfunction with severe MR [with preserved anatomy of mitral apparatus and viability],PCI has been able to drastically reduce the degree of MR from severe to mild in 34 cases and moderate MR in 8 cases. All patients improved symptomatically. Patients with papillary muscle rupture or no viability were excluded .Also, in 63 patients with >75 years of age with CAD and severe LV dysfunction, PCI has not only been able to reverse the degree of LV dysfunction, but in 29 patients LV dysfunction disappeared altogether. From 2011 to August 2019, total 481 cases were performed all anterogradely with 84%success rate.