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Left main percutaneous coronary intervention in ACS or stable coronary artery disease: acute and long-term results

Elisabetta Varani1, Sabine Vecchio, Matteo Aquilina

  • 1Cardiology Department, S. Maria delle Croci Hospital, Ravenna, Italy - ra.hocardioemo@ausl.ra.it.

Minerva Cardioangiologica
|March 19, 2016
PubMed

Insights

Percutaneous coronary intervention (PCI) for unprotected left main (UPLM) stenosis showed acceptable outcomes in ST-elevation myocardial infarction (STEMI) patients and good results in non-ST-elevation myocardial infarction/unstable angina (NSTEMI/UA) patients. Stable coronary artery disease (CAD) patients experienced very good results with UPLM PCI.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research
  • Clinical Outcomes

Background:

  • Unprotected left main (UPLM) percutaneous coronary intervention (PCI) is a complex procedure.
  • Assessing outcomes in unselected patients with acute coronary syndrome (ACS) or stable coronary artery disease (CAD) is crucial.
  • Evaluating PCI in a high-volume center without on-site cardiac surgery provides unique insights.

Purpose of the Study:

  • To evaluate in-hospital and long-term results of UPLM PCI.
  • To compare outcomes across different patient groups: ACS (STEMI, NSTEMI/UA) and stable CAD.
  • To identify predictors of mortality after UPLM PCI.

Main Methods:

  • Retrospective analysis of 317 UPLM PCI procedures performed between 2008 and 2011.
  • Patients were categorized into ST-elevation myocardial infarction (STEMI), non-ST-elevation MI/unstable angina (NSTEMI/UA), and stable coronary artery disease (CAD) groups.
  • In-hospital and 2-year follow-up data were collected and analyzed.

Main Results:

  • In-hospital mortality varied significantly: 20% for STEMI, 5.3% for NSTEMI/UA, and 1.7% for stable CAD (P<0.001).
  • Two-year total mortality was 24.5% (STEMI), 25.6% (NSTEMI/UA), and 6% (stable CAD).
  • Independent predictors of 2-year mortality included bare-metal stent use, high Syntax Score, ACS indication, peripheral artery disease, and age >75 years.

Conclusions:

  • UPLM PCI demonstrated acceptable short-term results in STEMI patients, with prognosis linked to hemodynamic status.
  • NSTEMI/UA patients had good initial results, but long-term mortality was influenced by comorbidities.
  • Stable CAD patients achieved very good outcomes following UPLM PCI.
Abstract

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