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Management of acute left main occlusion in surgical and non-surgical centers: a multicenter study
Session:
Posters (Sessão 2 - Écran 1) - DAC e Cuidados Intensivos 2 - Tronco comum e Idade
Speaker:
Mariana Silva Brandão
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana s. Brandão; Marta Braga; João Calvão; Andreia Campinas; André Alexandre; Bruno Brochado; João Carlos Silva; Gustavo Pires-Morais; Pedro Braga; Marisa Passos Silva; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Myocardial infarction due to acute left main coronary artery (LM) occlusion (ALMO) is often catastrophic, with frequent need for mechanical circulatory support (MCS) and surgery. We aimed to compare the management of patients (pts) with ALMO in surgical and non-surgical centers.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Multicenter retrospective study including 2 surgical centers (SC) and 1 non-surgical center (NSC). All patients presenting with unprotected ALMO (Thrombolysis In Myocardial Infarction [TIMI] ≤ 2) between January 2008 and December 2020 were included.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: 128 patients (age 63.4±11.4 years, 74.2% male) were included (SC: n=85, 66.4%; NSC: n=43, 33.6%). Baseline characteristics were comparable between groups.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In SC, more patients presented with total (TIMI 0) ALMO (56.5% <em>vs </em>25.6%, p<.001) and with cardiogenic shock (69.4% <em>vs </em>41.9%, p=.006). Use of MCS was more frequent in SC (75.3% <em>vs </em>20.9%, p<.001), as were device-related complications (p=.002). The intraaortic balloon pump was the mainly used device in both groups (n=66); duration of support was longer in SC (2.3±2.9 <em>vs </em>0.8±1.5 days, p=.026). Concomitant use of >1 MCS device (n=14), use of venoarterial extracorporeal membrane oxygenation (n=19) and Impella (n=2) were exclusive of SC. Use of vasopressors (80.7% <em>vs</em> 51.2% p<.001) and mechanical ventilation (60.0% <em>vs </em>37.2%, p=.024) was more common in SC.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Radial access was used less often in SC (12.9% <em>vs </em>51.2%, p<.001). In both groups, pts were mostly treated with PCI (84.3% <em>vs </em>97.6%, p=.059). Thrombectomy was performed more often in SC (38.8% <em>vs </em>19.0%, p=.041), whereas stent implantation in the index procedure was rarer (64.7% <em>vs </em>86.0%, p=.02). Multivessel disease was rarer in SC pts (12.9% vs 46.5%, p<.001). More patients in SC underwent coronary artery bypass grafting [CABG](15.3% <em>vs </em>2.3%, p=.026).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In-hospital mortality was comparable (56.5% <em>vs </em>48.8%, p=.528). Need for reintervention in the LM was found solely in NSC patients (9.3% vs 0%, p=.019), all previously treated with PCI. During a mean follow-up of 1.6 ± 2.8 years, mortality remained comparable between groups (<em>Log rank </em>test, p=.572).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>Disparities in the access to therapies still pose a challenge to acute cardiovascular care teams. Management in SC was related to more frequent and longer use of MCS and supportive therapies, and of CABG. Despite a higher rate of multivessel disease, CABG was rare in NSC patients. Still, in-hospital and long-term outcomes were comparable between SC and NSC. </span></span></p>
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