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Percutaneous Coronary Intervention for Unprotected Left Main Disease in Acute Coronary Syndromes: in-hospital and mid-term (three years) follow-up
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
André Dias de Frias
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:
André Dias De Frias; André Luz; Ricardo Costa; Andreia Campinas; Anaisa Pereira; André Alexandre; Patrícia Rodrigues; Raquel Baggen-Santos; Bruno Brochado; João Silveira; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Introduction</u>: Percutaneous coronary intervention (PCI) of unprotected left main artery (ULM) is increasingly emerging as a valid option, not only in low-SYNTAX score patients, but also in high-surgical risk patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Aim</u>: To evaluate the in-hospital and 36-month outcomes of patients undergoing ULM PCI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: Retrospective study of all consecutive patients who underwent ULM PCI at our Centre between 2008 and 2017. Clinical follow-up was conducted for a total of 36 months in all patients. Major adverse cardiovascular events (MACE) was defined as a composite of all-cause death, target lesion failure (TLF) and non-fatal/non-TLF myocardial infarction (MI).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results</u>: 72 patients were included, 71% males with median age 65.5 [interquartile range (IQR) 57.25-79] years. 35% were diabetics and 21% had history of MI. The indication for ULM PCI was non-ST segment elevation acute coronary syndrome (NST-ACS) in 71% and ST-segment elevation myocardial infarction (STEMI) in 29% of cases. Patients presented in Killip class III/IV in 19% and class IV/IV in 24% of cases, respectively. Median Syntax Score and EuroScore II were 27 (IQR 19.000-36.875) and 5.195 (IQR 2.1100–16.2725), respectively. Distal left main was involved in 50% of cases. 20% of NST-ACS patients did not undergo Heart Team evaluation due to hemodynamic instability, while surgical risk was the commonest refusal reason (66%). In-hospital mortality was 19% (7.8% NST-ACS; 47.6% STEMI; 100% of deaths occurred in Killip class ≥ III/IV at presentation); 3% had a periprocedural stroke (1 posterior circulation infarct and 1 lacunar cerebral infarct) and 1% had sub-acute stent thrombosis. At 36 months of follow-up, MACE occurred in 38% of the 58 in-hospital survivors: 14% had TLF, 5% non-fatal MI and 22% died. In univariate analysis, STEMI (p<0.001), lower creatinine clearance (p=0.003), higher Killip class at presentation (p<0.001), SYNTAX score (p<0.001) and EuroScoreII score (p<0.001) were associated with in-hospital mortality, while age was not (p=0.921). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u>: Our study showed that ULM PCI is a feasible option in the treatment of acute coronary syndromes, with good in-hospital results for the non-critical patient and acceptable results at 36 months follow-up. </span></span></p>
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