SPC365

Distal left main percutaneous coronary intervention: does the clinical scenario change the outcome?

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Carolina Saleiro

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters
FP Number: ---
Authors: Carolina Saleiro; Joana m Ribeiro; João Lopes; Diana de Campos; José p Sousa; Joana Silva; Luís Paiva; Hilário Oliveira; Marco Costa; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: &nbsp;</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Left main (LM) coronary artery stenosis is a known predictor of morbi/mortality. Coronary artery bypass grafting is the treatment of choice for most patients with distal LM stenosis, but percutaneous coronary intervention (PCI) is a valid alternative in selected cases.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;<strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">To compare the outcomes of patients undergoing distal LM PCI, according to the clinical presentation: chronic (CCS) vs acute coronary syndrome (ACS). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,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">50 consecutive LM PCIs at a single centre between 2010-2017 were included and divided into Group A (CCS &ndash; N=30) and Group B (ACS, N=20). C<span style="color:black">linical, procedural and follow-up data were recorded. The study endpoints were procedural complications, all-cause mortality and coronary artery disease (CAD) progression. Median follow-up time was 20 (11-52) months. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">The mean age of 69&plusmn;10</span></span> <span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">years and there was a male predominance (74%). Baseline characteristics were balanced between groups. There was a high prevalence of cardiovascular risk factors (dyslipidaemia - 86%, hypertension - 86%; diabetes - 54% and smoking - 35%). In Group B, 25% presented with STEMI. 3- vessel disease was frequent (48%), and the mean Syntax score was 28&plusmn;10. The preferred technique was provisional stenting (72%) and intracoronary imaging was performed in 26% (8% OCT, 18% IVUS). Drug eluting stents were used in 86%. TIMI 3 flow was achieved in 96% of the cases. All the procedural details were similar in both groups. Radiation dosage was higher in group B (P=0.029), but fluoroscopy time and contrast dosages were comparable. Periprocedural complications were similar in both groups: dissection in 7%, cardiac arrest in 2%. CAD progression was comparable between groups. 15% of the patients had coronary artery disease progression, with 7% presenting with LM stent restenosis; 11% had an ACS during follow-up; but there were no stent thrombosis. 2 patients died during hospital stay and 10 during follow-up. Kaplan-Meyer curves showed a decreased survival among patients in group B (61 vs 41, Log RanK P=0.024 &ndash; Figure 1). <span style="color:black">After adjustment for the bifurcation technique (provisional vs 2-stent), only age (HR 1.09, 95% CI 1.00-1.19) and clinical context remained predictors of outcome (HR 4.91, 95% CI 1.31-18.26).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,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"> &nbsp;Distal LM PCI performed in the context of an ACS did not result in an increase in procedural complications or non-fatal ischaemic events, as compared to patients treated for CCS, but was associated with an increased long-term mortality.</span></span></span></span></p>