SPC365

Percutaneous Coronary Intervention for Left Main Coronary Artery: Acute and Chronic Disease

Session: SESSÃO DE POSTERS 40 - INTERVENÇÃO CORONÁRIA
Speaker: Sofia Nogueira Fernandes

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: Sofia Nogueira Fernandes; Mónica Dias; Carla Ferreira; Filipe Vilela; Inês Conde; Jorge Maques; Sérgia Rocha; Cátia Oliveira; Carlos Braga
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> For several years, coronary artery bypass grafting has been&nbsp;the standard choice of revascularization for significant left main (LM) coronary artery disease (CAD). However, with advancements in percutaneous coronary intervention (PCI) procedures, it has become a reasonable alternative in a significant portion of patients. The aim of this study was to characterize procedures and evaluate patients&rsquo; outcomes, after PCI for LM CAD.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> A retrospective&nbsp;study performed from January 2019 to December 2022, in patients submitted to PCI in LM CAD&nbsp;for chronic coronary syndromes (CCS) or acute coronary syndromes (ACS), with drug eluting stents. Demographic, clinical, angiographic, and procedural data were collected. Clinical outcomes, including major adverse cardiac and cerebrovascular events (MACCE), were assessed during follow-up.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#4ea72e">: </span></span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">A total of 107 patients were submitted to PCI in LM CA, including 19 with CCS and 88 with ACS. Most patients were male (80,4%), with an average age of 68.6&plusmn;11.3 years, with cardiovascular risk factors. The follow-up was 1120.7&plusmn; 573.7 days.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Among patients with CCS, most patients had low to intermediate SYNTAX score. Use of complementary diagnostic devices was more frequent in the CCS group (<em>p</em> &lt; 0.05). During hospitalization, patients did not develop any complications<span style="color:#4ea72e">. </span>Over the follow-up period, 5,3% (n=1) patients died of unknown cause and no cardiovascular deaths were registered. In the ACS group<span style="color:#4ea72e">,</span> 67% (n=59) had non-ST segment elevation myocardial infarction (MI), 23,9% (n=21) had ST segment elevation MI and 9,1% (n=8) had unstable angina. Cardiogenic shock (CS) was present in 13,6% (n=12) of them (Table 1). Regarding the patients admitted in CS, in-hospital mortality was significantly higher compared with patients with no CS (33,3% vs 4,2%, p&lt;0&lt;001). During follow-up, 6,8% (n=6) of patients had cardiovascular-related hospitalizations, and one patient died during the re-hospitalization from severe heart failure. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Over the follow-up period, the ACS group showed a higher incidence of MACCE compared to the CCS group (40.9% vs. 15.8%, <em>p</em> = 0.039). All-cause mortality was significantly higher in the ACS group (29.5% vs. 5.3%, <em>p</em> = 0.027). The rate of hospital readmissions due to cardiac symptoms was similar between groups (6.8% in ACS vs. 5.3% in CCS, <em>p</em> = 0.804). There were no significant differences in cardiovascular mortality (<em>p</em> = 0.344), stroke (<em>p</em> = 0.474), or myocardial infarction (<em>p</em> = 0.893). In-hospital mortality occurred exclusively in the ACS group (9.1% vs. 0%, <em>p</em> = 0.172).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> PCI for LM CAD is generally considered a safe treatment option, demonstrating relatively favourable outcomes. Patients presenting with ACS had significantly worse outcomes compared to CCS patients, including higher MACCE rates and all-cause mortality. Additional studies with longer follow-up periods are required to confirm these findings.</span></span></span></span></p>