Percutaneous coronary intervention in patients with unprotected left maincoronary artery stenosis: Short and long term outcomes
Presenter
Ouday Benabdeljelil, PhD, Cardiology departement La Rabta Hospital, Tunis, Tunisia
Ouday Benabdeljelil, PhD, Farès Azaiez, Selim Boudiche and Mohamed Sami Mourali, Cardiology departement La Rabta Hospital, Tunis, Tunisia
Keywords: Acute Coronary Syndromes (ACS), Coronary and Left Main and Bifurcations
Background
Though infrequent, unprotected left main coronary artery (ULMCA) stenosis has a major prognostic impact. The aim of our study was to evaluate clinical outcomes of ULMCA percutaneous coronary intervention (PCI) with stent implantation in a "real world" population.
Methods
This was a single-center prospective observational study of all patients with ULMCA stenosis treated by PCI in the cardiology department of La Rabta hospital between January 2012 and December 2017.
Results
A total of 150 consecutive patients were included. The mean age was 64.4±12.1 years. The sex ratio was 3. Diabetes was present in 50.7% of patients. Of note, 20.7% of the patients were revascularized in emergency and 3.3% were in cardiogenic shock. The distal LMCA was involved in 76.7% of the lesions. A majority of patients (94.0%) had low or intermediate SYNTAX Score I. Median SYNTAX score II was 31.1 [22.2-39.8] with a predicted PCI four-year mortality of 7.5%. PCI, apart from emergency, was mainly performed by new generation drug-eluting stents (78.7%). Among distal left main PCI, a provisional approach was mostly used (81.7%) and proximal optimization technique was almost systematic (92.2%). When a two-stent approach was chosen, kissing balloon was performed in 95.2% of cases. Intravascular ultrasound was used in 2.7% of the procedures and rotational atherectomy in 8.7%. In-hospital mortality was 2.7%. The median follow-up was 13.4 months [5.1-24.1]. The rate of major adverse cardiac events was 23.3% with an estimate according to Kaplan Meier method of 23.2%, 35.0% and 37.9% respectively at one, three and five years. Significant predictors of increased major adverse cardiac events were previous PCI, cardiogenic shock, the use of bare-metal stents for left main coronary artery PCI and SYNTAX score II≥30.
Conclusions
PCI of ULMCA is a reasonable alternative to coronary artery bypass grafting with encouraging short and long term outcomes. SYNTAX score II would predict the occurrence of major long-term cardiac events.