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Published on: August 9, 2024
Unprotected left main percutaneous coronary intervention: prognostic value of SYNTAX score II
Insights
Unprotected left main percutaneous coronary intervention (PCI) shows promising outcomes. SYNTAX score II may predict long-term results in patients with this complex coronary artery disease.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Unprotected left main (LM) coronary artery disease (CAD) poses significant prognostic challenges.
- Percutaneous coronary intervention (PCI) is a key treatment modality for LM CAD.
Purpose of the Study:
- To assess clinical outcomes and identify predictors of major adverse cardiac events (MACE) after unprotected LM PCI.
- To evaluate the safety and efficacy of LM PCI in an "all-comers" patient cohort.
Main Methods:
- Prospective observational study including 150 patients undergoing unprotected LM PCI.
- MACE defined as all-cause death, myocardial infarction, or target lesion revascularization.
- Follow-up duration averaged 13.4 months.
Main Results:
- The 5-year MACE estimate was 37.9%, with an observed MACE rate of 23.3%.
- Significant MACE predictors included cardiogenic shock, bare metal stent use, prior PCI, and SYNTAX Score II ≥30.
- Drug-eluting stents were predominantly used (78.7%).
Conclusions:
- Unprotected LM PCI demonstrates favorable short- and long-term clinical outcomes.
- SYNTAX Score II may serve as a valuable predictor for long-term prognosis in unprotected LM PCI patients.
Background:
Unprotected left main (LM) coronary artery disease (CAD) represents a challenging lesion with a major prognostic impact.
Aim:
Evaluate the clinical outcome and major adverse cardiac events (MACE) predictors of unprotected LM percutaneous coronary intervention (PCI) in an "all-comers" population.
Methods:
We performed a prospective observational study of patients with unprotected LM stenosis treated by PCI. MACE were defined as the composite endpoint of all-cause death, myocardial infarction and target lesion revascularization.
Results:
From January 2012 to December 2017, 150 consecutive patients who underwent unprotected LM PCI were included. The mean age was 64±12 years and 75.3% were males. Diabetes was noted in 50.7%. Emergent revascularization was performed in 20.7% of cases, including 3.3% patients with cardiogenic shock. Distal LM was involved in 76.7% of cases. A majority of patients (94.0%) had low or intermediate SYNTAX Score I (≤32). The median SYNTAX score II was 31.1. Drug-eluting stents were used in 78.7% and bare metal stents in 21.3% of patients, mainly in emergent setting where the former were unavailable. In distal LM PCI, provisional approach was mostly used (81.7%). The median follow-up was 13.4 months. MACE occurred in 23.3% with an estimate of 37.9% at 5 years. Significant predictors of MACE were cardiogenic shock, bare metal stents use, previous PCI, and SYNTAX score II ≥30.
Conclusion:
Unprotected LM PCI presents encouraging short and long term outcomes. SYNTAX score II might represent a predictor for long-term outcome in this particular lesion subset.
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