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Clinical outcomes in left main percutaneous intervention: can we do better?
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
Gustavo M. Campos
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:
Gustavo M. Campos; Luís Leite; Manuel Oliveira Santos; Luís Paiva; Elisabete Jorge; Joana Silva; Vítor Matos; Hilário Oliveira; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif"">Introduction: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif"">C<span style="background-color:white">oronary artery bypass grafting surgery (CABG) is established as the standard revascularization strategy for patients with left main (LM) coronary disease. </span><span style="color:black">Recent advances in drug-eluting stents have begun to level the playing field between percutaneous coronary intervention (PCI) and CABG.</span><span style="background-color:white"> Different randomized clinical trials have shown the safety and efficacy of PCI as an alternative to CABG, especially in patients with low coronary complexity. As such, c<span style="color:black">oronary angioplasty is being increasingly performed in left main coronary artery lesions. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives:</strong> To assess the effect of selected clinical and angiographic characteristics as well as procedure techniques on long-term clinical outcomes of PCI in patients with LM disease.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective, observational study including patients who underwent non-emergent LMCA angioplasty between January 2010 and December 2019. Data was collected from the emergency department and hospitalization registries. Multivariate model with Cox regression was elaborated including all clinical, analytical and angiographic significant variables identified in univariate analysis for the compose outcome of death or myocardial infarction. </span></span></p> <p style="text-align:justify"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong><span style="font-size:11pt"> A total of 179 patients were included (median age 72 </span><span style="background-color:white; font-size:11pt">[65-80]</span><span style="font-size:11pt">, 134 (74.8%) males). Median follow-up was 27 </span><span style="background-color:white; font-size:11pt">[12-53] months. Median SYNTAX score was 23</span> <span style="background-color:white; font-size:11pt">[15-31]</span><span style="font-size:11pt">. Long-term all-cause mortality was 66 (36.9%). Myocardial infarction at follow-up occurred in 16 (8.9%)</span><span style="font-size:11pt">. Cerebrovascular events occurred in 4 (2.2%). Concerning the PCI procedural and clinical aspects with impact on the compose outcome (death or myocardial infarction), we found in the multivariate analysis that the independent predictors were the use of intravascular imaging (HR 0.34, CI 0.16 to 0.73, p = 0.006) and an left ventricular </span><span style="font-size:11pt">ejection fraction ≤ 50% (HR 1.96, CI 1.07 to 3.61, p = 0.030).</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif"">Conclusions:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif""> Intravascular imaging-guided PCI in LM disease has an important prognostic impact on long-term outcomes and its routine use is crucial to be a competitive revascularization strategy.</span></span></p>
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