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Percutaneous coronary angioplasty of left main coronary artery: do we EXEL?
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="background-color:white"><span style="font-family:"Calibri","sans-serif""><span style="color:black">Left main coronary artery (LMCA) disease is associated with increased morbidity and mortality. Early clinical trials comparing coronary artery bypass grafting surgery (CABG) with medical therapy showed better outcomes with CABG, establishing surgery as the standard revascularization strategy for this group of patients. More recently, different randomized clinical trials have shown the safety and efficacy of percutaneous coronary intervention (PCI) as an alternative to CABG, especially in patients with low coronary complexity.</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> We aimed to determine the characteristics and outcomes of a cohort of patients admitted to the catheterization laboratory and submitted to LMCA angioplasty.</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 LMCA PCI between January 2010 and December 2019. Data was collected from the emergency department and hospitalization registries. Patients were divided according to the urgency of the procedure. We made a global analysis including baseline clinical and angiographic data. Finally we aimed to study the clinical outcomes (in-hospital and long-term all-cause mortality, myocardial infarction and cerebrovascular events at follow-up) excluding patients from the urgent subset, in which CABG was not considered an alternative.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results<span style="color:black">:</span></strong><span style="color:black"> A total </span>of 242 patients were included (median age 72 <span style="background-color:white">[64-81]</span>, 182 (75.2%) males). The baseline characteristics of the study population are listed in table 1. Median follow-up was 27 <span style="background-color:white">[12-53] months. Urgent revascularization was associated with higher in-hospital mortality (14/63 (22.2%) vs 7/179 (3.9%); p <0.001). </span>Long-term all-cause mortality for elective procedures was 66 (36.9%). Myocardial infarction at follow-up occurred in 16 (8.9%) patients and angiographic evidence of stent re-stenosis was 14 (7.8%). Cerebrovascular events occurred in 4/142 (2.2%). Only 2 (1.1%) patients needed subsequent CABG.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>In this analysis we present the experience with LMCA angioplasty in a terciary center. LMCA angioplasty in the emergency setting remains a challenge <span style="background-color:white"><span style="color:black">and is associated with increased mortality in the short term. However, its becoming an increasing alternative to CABG in selected patients.</span></span></span></span></p>
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