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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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32. Cardiovascular Nursing
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Left main percutaneous coronary intervention with second generation drug-eluting stents
Session:
Posters 5 - Écran 1 - Doença Coronária
Speaker:
Cátia Costa Oliveira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Cátia Costa Oliveira; Carlos Galvão Braga; Isabel Durães Campos; Paulo Medeiros; Carla Rodrigues; Rui Files Flores; João Costa; Jorge Marques
Abstract
<p><strong>INTRODUCTION:</strong> Improved percutaneous coronary intervention (PCI) has reduced its complications in the treatment of left main (LM) coronary disease.</p> <p><strong>AIM:</strong> To characterize patients and procedures with LM PCI and to evaluate their outcomes. </p> <p><strong>METHODS:</strong> Single-center, retrospective study performed from January 2015 to December 2017 in patients with LM PCI with second-generation drug-eluting stents (n=67).</p> <p><strong>RESULTS: </strong>Patients with LM PCI were mainly male (68.7%) with median age of 70.1 years. 57.1% of patients were diabetic and 52.% had reduced ejection fraction. Previous CABG was presented in 20.9% (only patient had unprotected LM). The SYNTAX score was low (22 or less) in 56.6%, intermediate (22 to 32) in 30.2% and high (33 or higher) in 13.2%. Distal LM bifurcation PCI was performed in 79.1% and 73% of patients had two-vessel or three-vessel disease. 13.2% of patients with distal disease were treated with a two-stent technique (1 with T-stent, 2 with TAP, and 4 with culotte technique), in which proximal optimization technique (POT) and kissing balloon were always performed. When one-stent technique was used in distal LM, POT was performed in 66.0% and kissing balloon in 25%. Pre and post dilatation were performed in 91.0 and 82.1% of all cases, respectively. Indications for PCI were elective PCI for stable angina (n=18), stabilized NSTEMI (n=20), NSTEMI with ongoing instability (n=10), STEMI (n= 16), and non-culprit lesion treatment after primary-PCI for STEMI (n=3). 22.4% of patients were in cardiogenic shock. After our first LM PCI guided with intracoronary imaging, 38.6% of the procedures were performed with it. 14.6% of patients died during the hospitalization (1 with stent thrombosis; 9 were in cardiogenic shock). All patients had at least 1 year of follow-up. At follow-up, 13.2% of patients died. 85% of deaths were non-cardiovascular; cardiovascular deaths were due to heart failure. Non-fatal myocardial infarction occurred in 7.5% patients with 2 patients undergoing unplanned PCI (one with LM PCI). Target lesion failure occurred in 4 patients (1 had fatal stent thrombosis; 3 had stent restenosis; 2 were send to CABG and 1 was treated with PCI). One patient had a stroke during hospitalization and other during follow-up.</p> <p><strong>CONCLUSION:</strong> LM PCI can be considered as an alternative revascularization in urgent situations when surgery cannot be considered. Though it can be a high-risk subset, the results in our population are encouraging.</p>
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