SPC365

Navigating the Coronary Crossroads: Left main artery bifurcating lesions, a single centre PCI results

Session: SESSÃO DE POSTERS 40 - INTERVENÇÃO CORONÁRIA
Speaker: Rita Louro

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Cartazes
FP Number: ---
Authors: Rita Louro; Rafael Viana; Carla Silva; Orlando Luquengo; Marta Figueiredo; António Almeida; Miguel Carias; David Neves; Ângela Bento; Renato Fernandes; Gustavo Sá Mendes; Lino Patrício

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>BACKGROUND: </strong><span style="font-family:&quot;Aptos Light&quot;,sans-serif">The management of patients with left main coronary artery (LM) disease presents a dilemma in medicine, with the ongoing debate between the efficacy of the percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), current literature favours CABG in SYNTAX &ge;22, due to more complex coronary anatomies.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>METHODS: </strong><span style="font-family:&quot;Aptos Light&quot;,sans-serif">Retrospective analysis, in a single centre between 2010 and 2024, of 114 patients with bifurcating LM disease treated percutaneously to evaluate cardiovascular outcomes compared to those of the literature. The primary outcome was composed of death from cardiovascular causes, myocardial infarction, stroke, or target lesion revascularization. Results at this centre were compared with expected cumulative long-term major adverse cardiac and cerebrovascular events (MACCE) for PCI and CABG in SYNTAX. Expected results were retrieved from the SYNTAX Score logistic regression.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>RESULTS: </strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">A total of 113 patients were included, with a median follow-up (FUP) of 38 months (10 lost to FUP). Regarding baseline characteristics, the population had a mean age of 70.8&plusmn;11.1 years, 77.2% were men. The presentation was chronic coronary syndrome (CCS) in 42.1% and STEMI in 30.7%. The mean SYNTAX score was 27.0&plusmn;11.8. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">Patients with more complex coronary anatomy, as described in the literature, exhibit higher rates of MACCE: 18.9% for SYNTAX &lt;22, 19.5% for SYNTAX 22-33, and a significantly higher 42.9% for SYNTAX &ge; 33, detailed outcomes are presented in the table. These MACCE results, according to SYNTAX Score, are lower than expected for percutaneous approach and comparable to CABG in SYNTAX &lt;22 and 22-33. In SYNTAX &ge; 33, the MACCE rate was higher than expected for PCI and CABG. A subgroup analysis of patients with SYNTAX &ge;33 revealed a MACCE rate of 25% in those presenting with chronic coronary syndrome (CCS). </span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>CONCLUSIONS</strong><span style="font-family:&quot;Aptos Light&quot;,sans-serif">: </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">Although the Syntax Score is an older tool, it remains valuable for patient stratification and should not be abandoned, as it provides an assessment of disease burden. In patients with a Syntax &lt; 33, PCI outcomes in our experience are comparable to CABG, </span></span></span><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">even with the inclusion of acute coronary syndromes (ACS). &nbsp;In p</span></span></span><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">atients with Syntax &gt; 33 CABG remains slightly superior in CCS (25% vs 21.9%) due to the higher disease burden. However, in ACS PCI is often performed due to the impossibility of CABG.</span></span></span> <span style="font-size:12pt"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">These results suggest that the percutaneous approach is a valid solution, particularly in the context of long surgical waiting lists.</span></span></span></p>