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Clinical impact of routine angiographic follow-up after percutaneous coronary interventions on unprotected left main
Cristina Aurigemma, Francesco Burzotta1, Italo Porto
1Istituto di cardiologia Università Cattolica del Sacro Cuore. francesco.burzotta@unicatt.it.
Insights
Routine follow-up angiography after drug-eluting stent percutaneous coronary intervention on the unprotected left main artery may reduce major adverse cardiac events. This approach warrants further investigation in randomized trials.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Unprotected left main (ULM) percutaneous coronary intervention (PCI) with drug-eluting stents (DES) presents a complex clinical scenario.
- The necessity of routine follow-up coronary angiography in these patients remains a subject of debate.
Purpose of the Study:
- To evaluate the impact of routine follow-up coronary angiography versus clinical follow-up on major adverse cardiac events (MACE) in patients undergoing DES PCI on ULM.
Main Methods:
- A cohort of 190 patients with successful DES implantation on ULM and no early adverse events were analyzed.
- Patients were divided into two groups: routine control angiography (CA) and clinical follow-up (CF).
- The primary endpoint was MACE, defined as cardiac death, myocardial infarction, or urgent target vessel revascularization.
Main Results:
- After a mean follow-up of 35 months, MACE rates were significantly lower in the CA group (4.3%) compared to the CF group (16.2%).
- Multivariable analysis indicated that CA was associated with a reduced risk of MACE.
- The reduction in MACE was primarily driven by a lower cardiac death rate in the CA group.
Conclusions:
- Routine coronary angiography following complex PCI, specifically ULM PCI with DES, is associated with a significant reduction in MACE.
- These findings suggest that routine angiography may be beneficial in managing patients with ULM PCI.
- Further validation through appropriately designed randomized controlled trials is recommended.
Background:
Patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) on unprotected left main (ULM) represent a complex subset. The role of routine coronary angiography at follow up in this subset remains debated.
Methods:
At the documented center, all patients undergoing successful PCI on ULM lesions performing angiographic follow-up is suggested, but adherence to such a recommendation is inhomogeneous. Consecutive patients undergoing DES PCI on ULM were enrolled and experienced no adverse events during the first 6 months. Patients were then allocated to two groups: those undergoing routine control angiography (CA) and those undergoing clinical follow-up (CF). Primary endpoint was major adverse cardiac events (MACE) defined as cardiac death, myocardial infarction and urgent repeat target vessel revascularization.
Results:
A total of 190 patients underwent successful DES implantation on ULM and the study population was without early events. CA was performed at 6 months after the index procedure in 91 (48%) patients. After 35 ± 21 months, MACE rates were significantly more common in the CF group as compared with the CA group (16.2% vs. 4.3%, p = 0.009). At multivariable analysis, CA was associated with reduced MACE risk (HR 0.13, 95% CI 0.1-0.7, p = 0.028). Of note, this was mainly driven by higher cardiac death rate in those undergoing CF than in those undergoing CA (p = 0.01).
Conclusions:
CA after complex PCI, such as ULM PCI, is associated with reduced MACE. Such an observation calls for appropriately designed randomized trials.
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