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PCI of left main coronary artery: real life Vs clinical trials outcome results
Session:
Posters (Sessão 6 - Écran 7) - Intervenção Coronária e Estrutural 4 - Doença coronária
Speaker:
Hugo Costa
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Hugo Alex Costa; Miguel Espirito Santo; Raquel Fernandes; Teresa Faria da Mota; Hugo Palmeiro; Daniela Carvalho; João Bispo; João Guedes; Hugo Vinhas; Ilídio Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong>Introduction: </strong>The treatment of choice of left main coronary artery (LMCA) disease has been subject to intense debate and investigation in the last decade. Although it is not the standard of care, PCI of LMCA has been increasing. It is important to compare real life outcome results with those described in clinical trials, justifying the use of this technique. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong>Objective: </strong>Population characterization. Try to identify prognostic factors and outcomes of LMCA PCI comparing with those described in recent clinical trials.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong>Methods:</strong> Retrospective study between 2019/2020, composed of n=120 patients that were submitted to LMCA PCI. Descriptve analysis was carried out regarding the demographic and clinical characteristics of the patients. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%, and the results were compared with 3 clinical trial data. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong>Results:</strong> A total of 120 patients were identified, with a mean age of 70.5 ± 10.8 years, 76.7% were male. 81.7% had multivessel disease, with LMCA plus 1 artery in 54.1% (anterior descendig artery most frequent (31.7%)). Compared to reference trials, besides being older, they also had more comorbidities like hypertension (75%), previous myocardial infarction (50.9%), chronic renal failure (CRF) (8.3% - p=0.019), lower left ejection fraction (49.5±11.1) and presented more often with acute coronary syndrome (72.5%). Heart failure (3.4% - p=0.02) and CRF were independente prognostic factors. In general, they were less fit for surgery (EURO score 4.0±3.8) and presented with more complex coronary anatomy (SYNTAX score 27.3±12.2). At 2 years, outcomes of death (10.0%), myocardial infarction (MI) (8.8%) or ischemia-driven revascularization (IDR) (1.8%) were similar to EXCEL and NOBLE trials at 2 years, and higher compared to PRECOMBAT trial, probably because this included younger patients with less comorbidities and better left ventricular function. The use of intravascular ultrasound in our sample was low (18.3%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong>Conclusion: </strong>After 2 years follow up, we report outcomes of mortality, MI and IDR of patients submitted to LMCA PCI similar to the 3 biggest trials in the field. It is importante to highlight that our pool of patients presented with worse overall general status, reinforcing the usefullness of this technique in selected cases.</span></span></p>
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