026 Immediate and long term outcomes after unprotected left main coronary artery angioplasty
Archives of Cardiovascular Diseases Supplements(2011)
Abstract
Although cardiac surgery is still considered as the gold standard of care for patients with unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) is emerging as a possible alternative. To evaluate immediate and long term outcomes of PCI in an unselected cohort of patients with ULMCA disease. 246 consecutive patients who underwent ULMCA angioplasty in a single high volume centre over a 5-year period were included. Major adverse cardiac events were defined as a combined end point of cardiac death, non fatal myocardial infarction (MI), or target lesion revascularisation (TLR). 2 sided p values<0.05 were considered statistically significant. Mean age was 72.5 ± 11.3. 185 patients (75.2%) were males; 60 (24.4%) had diabetes mellitus and 62 (25.2%) had peripheral artery disease. Mean additive EuroSCORE value was 7.1 ± 4.5 and mean predicted surgical mortality by logistic EuroSCORE was 14%. For distal LM lesions (56%), the provisional side-branch T-stenting approach was used in 81% of cases and final kissing balloon inflation in 92%. DES were used in 32% of cases. Angiographic success was obtained in 99.6% of cases. In hospital mortality was 1.6% After a mean follow up of 30.42 months, rates of cardiac deaths, TLR and MACE were respectively 8.5% (21 cases), 11% (27 cases) and 19.9% (48cases). On multivariate analysis, EuroSCORE >6 was the only independent predictor of cardiac death (HR = 3.1 95% IC [1.2–8.3], p = 0.028); predictors of MACE were EUROSCORE>6 (HR = 1.95 95% IC [1.05–3.6], p = 0.032) and distal LM lesions (HR = 2.02, 95% IC [1.04–3.9], p = 0.037).Conversely, neither initial clinical presentation nor stent type affected outcome. ULMCA stenting with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good long term clinical outcomes. Long term predictors of death were Euro-SCORE values>6 and distal LM lesion.
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Key words
Cardiac Imaging,Cardiovascular Risk Assessment
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