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026 Immediate and long term outcomes after unprotected left main coronary artery angioplasty

Archives of Cardiovascular Diseases Supplements(2011)

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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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