Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
One stent versus two stents for distal LM PCI: insights from the experience of a high volume center
Session:
Painel 11 - Cardiologia Intervenção 2
Speaker:
Rafael Santos
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:
Rafael Santos; Miguel Nobre Menezes; P. Carrilho Ferreira; E. Infante de Oliveira; Claudia Jorge; J. Almeida Duarte; Pedro Pinto Cardoso; José Marques da Costa; Diogo Torres; João Marques; Ana Rita G. Francisco; Tiago Graça Rodrigues; Pedro Silvério António; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction</strong>: distal left main (LM) PCI remains a challenge. One of the most debated issues is whether to use a single vs 2 stent provisional strategy. While most studies and guidelines favour a single stent strategy, the recent DK-CRUSH V trial has shown better results with a 2 stent strategy.</p> <p><strong>Objective</strong>: to evaluate the performance of a single vs dual stent strategy for LM PCI in a real-world population setting.</p> <p><strong>Methods</strong>: Single-center procedural prospective registry of patients (pts) submitted to LM PCI from 2015-2018, with retrospective event analysis. Demographic, clinical data and procedure characteristics were analysed. Results were obtained with χ2 test, T student test, Kaplan-Meier survival analysis, logistic and Cox regression.</p> <p><strong>Results</strong>: 100 pts (73 men; 69 ± 11 years) were included. Co-morbidities were very frequent (85 had hypertension, 54 had diabetes, 71 had dyslipidemia and 39 were past smokers). 32 had reduced LVEF (<40%) and 45 previous CABG. The decision to proceed to PCI vs surgery was undertaken individually by the local HeartTeam.</p> <p>Most of the procedures (57) were in an acute coronary syndrome setting (11 in STEMI, 7 with cardiogenic shock). The anatomical distribution of the lesions was: distal in 69 pts (61 involved the LAD and or Cx ostium), mid shaft in 7 pts, ostial in 18 pts and diffuse in 6 pts. Protected left main PCI encompassed 41% of the procedures.</p> <p>The complication rate was 7%. During a mean follow-up of 866 ± 400 days, there were 4 peri-procedural deaths, 1-year mortality rate of 10% and 22 pts died overall.</p> <p>In pts submitted to distal LM PCI, a single stent was used in 49 pts (66%) versus a 2 stent approach in 23 pts (31%). The only significant difference between these groups were diabetes (66% in the single stent vs 32% in the 2 stent group p = 0,006) and protected LM (51% in the single stent vs 26,1% in the two stent group p = 0,046).</p> <p>While a 2 stent strategy was associated with higher mortality by Kaplan Meyer analysis (LogRank=11.07, p=0.001), it was not an independent predictor of mortality in Cox regression. Cox univariate analysis identified LVEF <40% (OR 2,2 CI 1,01 – 4,9 p = 0,047) and complications (OR 3,1 CI 1,4 – 6,9 p = 0,004) as the only predictors of death. In multivariate analysis, only the latter was an independent predictor of mortality (OR 2,6 IC 1,1 – 5,9 p = 0,028). The use of a 2 stent strategy was significantly associated with complications (X2 = 5,1 p =0,024)) and was the only independent predictor of it (OR 3,8 IC 1,1 – 12,8 p = 0,03). This was true even in the subgroup of protected LM PCI.</p> <p><strong>Conclusion</strong>: in a real-world setting of challenging LM PCI cases, a single stent strategy for distal LM PCI performed better. The use of 2 stents was an independent predictor of complications, strongly associated with increased risk of death. While a LM PCI must be undertaken on an individual basis, a single stent provisional strategy, whenever feasible, seems to be the best option.</p> <p> </p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site