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Left main disease angioplasty: a real-life experience.
Session:
Painel 8 - Doença Coronária 9
Speaker:
Alexandra Briosa
Congress:
CPC 2020
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:
Alexandra Briosa; Ana Catarina Gomes; Inês Rangel; João Grade Santos; Ana Rita F. Pereira; Ana I. Marques; Daniel Sebaiti; Sofia Alegria; Gonçalo Jácome Morgado; Rita Calé; Cristina Dantas Martins; Helder Pereira; - On behalf of the investigators of the Portuguese Registry of Acute Coronary Syndromes
Abstract
<p><em><u>Introduction:</u></em> Left main disease (LMD) is a major cause of morbimortality in patients (pts) with acute coronary syndromes (ACS). The best therapeutic strategy is still a topic of great debate. Although coronary artery bypass surgery (CABG) remains the gold standard treatment, percutaneous coronary intervention (PCI) has gained importance, being a valid and safe strategy in terms of mortality. </p> <p><u>Aim:</u> To characterize the Portuguese population submitted to LM PCI, as well as to determine their long-term morbidity and mortality</p> <p><u>Methods:</u> A multicenter observational retrospective study was performed (2010-2019), including consecutive pts with non-ST elevation ACS and LM lesion of >/= 50%. Clinical, imaging, long term complications and mortality data were collected. An univariate analysis was used to compare pts submitted vs not submitted to LM PCI during hospitalization. </p> <p><u>Results:</u> 305 pts included, 52.1% (n=159) of which submitted to LMD PCI.</p> <p>Concerning baseline characteristics, LMD PCI group with a mean age of 72±11 years and a trend to have more women (28% vs 19%, p=0.058), although less dyslipidemia (63,2% vs 80,2% p=0.001), history of previous ACS (29.5% vs 52,5% p=0.001) or previous revascularization strategy (PCI – 16,6% vs 31,5% p=0.002 or CABG- 20.9 vs 54.8%, p< 0.001). They had higher rates of undertreatment with statin (55.1% vs 72.3% p=0.002), clopidogrel (24.4% vs 35.2% p=0.041) and beta-blocker (36.1% vs 61.9% p<0.001).</p> <p>At admission they had less typical chest pain (54,9% vs 68.9% p=0.021) and higher Killip Kimbal (KK) class (KK>2: 35.7% vs 22,4% p=0.012), intra-aortic balloon pump or non-invasive ventilation (5.7% vs 0% p=0.004 and 6.3% vs 0.7% p=0-009, respectively). </p> <p>Angiographically, they had less multivessel disease (37% vs 65.9% p<0.001) and the LMD was the culprit lesion in the majority of the pts (47.8% vs 1.5% p<0.001). DES implantation was the main choice (83.6% vs 0% p< 0.001), with 98.7% successful cases. </p> <p>Regarding morbidity, the LMD PCI group had higher rates of cardiogenic shock (10.3% vs 4.2% p= 0.043) and cardiac arrest (7.1% vs 1.4% p=0.016), as well as a trend higher atrioventricular block (3.2 % vs 0% p= 0.06). However, there were no differences between both groups concerning intra-hospital mortality or cardiovascular mortality/readmission during follow-up.</p> <p>Finally, when analyzing the trend for total LMD PCI procedures in Portuguese hospitals over the recent years, there was no statistically significant difference.</p> <p><u>Conclusion:</u> LMD PCI is nowadays a worldwide reality in the treatment of ACS pts. National experience show us that, despite being associated with high morbidity rates, it seems to be a safe procedure with regard to mortality.</p>
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