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A Decade of Urgent and Emergent unprotected Left Main Stem percutaneous coronary intervention: Outcomes from a Portuguese Cardiac Center
Session:
Sessão de Posters 42 - Revascularização de tronco comum
Speaker:
Rafael Silva Teixeira
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Rafael Silva Teixeira; Ines Neves; Fabio Nunes; Marta Leite; Andre Lobo; Marta Catarina Almeida; Alberto Rodrigues; Bruno Melica; Claudio Guerreiro; Gustavo Pires Morais; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background:</strong> Percutaneous coronary intervention (PCI) on unprotected left main stem (LMS) is increasingly considered a viable alternative to coronary artery bypass grafting (CABG), offering comparable outcomes and safety profiles in select patient groups.</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives:</strong> To assess the outcomes of unprotected LMS PCI in patients presenting with acute coronary syndrome at a tertiary Portuguese center over the previous decade. </span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> We retrospectively collected data on all LMS PCI procedures performed from September 2013 to September 2023 from the local PCI database and electronic patient records. We compared all-cause mortality across varying severities of presentation using Cox proportional hazards models.</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> Out of 428 patients undergoing LMS PCI, 115 (23%) received urgent/emergency intervention. Among these, 98 had unprotected LMS PCI. Males represented 70% of the cohort (n=69), with an average age of 67 ± 13 years. Anatomical distribution was as follows: 20% ostial left main (n=20), 9% shaft (n=9), 80% bifurcation (n=78), and 9% diffuse (n=8). Cardiogenic shock was present in 48% of patients (n=47) at presentation, and 42% (n=41) required mechanical circulatory support, including Impella (n=3), venoarterial ECMO (n=9), and IABP (n=29). The procedure was successful in 95% of cases, with no patients requiring emergency CABG transfer. Mortality was higher in patients presenting with cardiogenic shock (HR: 1.92; 95% CI: 1.02 to 3.62; p=0.04) and highest in those needing mechanical support (HR: 2.61; 95% CI: 1.73 to 4.96; p<0.01). The 12-month all-cause mortality rate stood at 65%. Intravascular imaging use rose from 14% in 2015 to 40% in 2023 (p for non-stationarity= 0.09) and was associated with radial access (OR: 2.59; 95% CI: 1.01 to 6.68; p<0.05). Mortality was lower with imaging (HR: 0.38; 95% CI: 0.17 to 0.86; p=0.02).</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> Urgent/emergent PCI for unprotected LMS has shown acceptable success rates, including for bifurcation lesions, without the need for emergency CABG. However, outcomes are less favorable for patients presenting with cardiogenic shock or requiring mechanical support. The increasing use of advanced imaging is correlated with improved survival, emphasizing its growing significance in the success of PCI procedures.</span></span></span></p>
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