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Risk stratification in unprotected left main coronary disease: do we have the tools?
Session:
Painel 11 - Cardiologia Intervenção 2
Speaker:
Rita Ventura Gomes
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Rita Ventura Gomes; Mariana Gonçalves; Sérgio Madeira; NELSON VALE; João Brito; Sílvio Leal; Luís Raposo ; Pedro de Araújo Gonçalves; Henrique Gabriel; Rui Campante Teles; Manuel Almeida
Abstract
<p><strong>Introduction</strong></p> <p>The evolution of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) techniques made the choice of the optimal revascularization strategy of unprotected left main coronary disease (ULMD) challenging. Scoring systems are useful tools for the decision-making process and for risk stratification.</p> <p><strong>Purpose</strong></p> <p>To evaluate the performance of the SYNTAX score I (SSI) and II (SSII) and Euroscore II (EII) in risk stratification and the outcome predictors of patients (pts) with ULMD, according to the treatment strategy chosen.</p> <p><strong>Methods</strong></p> <p>Retrospective single centre cohort study of 99 consecutive pts (age 72±12years; 67.7% male) with significant ULMD (defined as left main coronary artery [LMCA] stenosis >50%, with no patent arterial or venous bypass graft to left anterior descending artery), who were submitted to PCI (n=77) or CABG (n=22), between January 2010 and December 2018. Mean follow-up (FU) was 2,2±2,6 years.</p> <p>The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction (MI) and target lesion revascularization (TLR).</p> <p><strong>Results</strong></p> <p>During the FU period, there were 39 (28,1%) cardiovascular deaths, 10 (7,2%) non-fatal MI and 10 (7,2%) TLR.</p> <p>Pts submitted to PCI who had at least one adverse event (AE) had more severe coronary artery disease (higher SSII 45.9vs36.1, p=0.001; stenosis of LMCA >70% 74.2%vs48.9%, p=0.04), higher EII (4.53%vs2.35%, p<0.002), bare metal stents were a more frequent choice (29%vs6.5%, p=0.011), had less complete revascularization (29%vs54.3%, p=0.028), lower left ventricle ejection fraction (35%vs48%, p=0.001), lower estimated glomerular filtration rate (47vs65mL/min/1.73m<sup>2</sup>, p=0.004) and the coronarography was performed more frequently in the context of acute coronary syndrome (71%vs45.7%, p=0.023). By multivariate analysis only the SSII remained an independent predictor of the outcome (HR 1.046, CI 1.007-1.085, p=0.019).</p> <p>Pts who were submitted to CABG and had at leats one AE during FU had the same trends, however with no statistically significant differences.</p> <p>The ROC curve analysis for all cohort presented a weak discriminative capacity for SSI (AUC 0.580, CI 0.450-0.710, p=0.236) and an acceptable for SSII (AUC 0.733, CI 0.615-0.851, p=0.001) and EII (AUC 0.714, CI 0.591-0.837, p=0.002; Figure 1). The difference was not statistically significant (DeLong test p=0.784).</p> <p>The 39 pts who had a SSII favoring CABG had numerically more events (43.6%vs36.8%, p=0.546).</p> <p><strong>Conclusion</strong></p> <p>In a real-world ULMD population, risk scores presented a modest role in the risk stratification, both in chronic and acute coronary syndromes.</p>
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