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The impact of coronary artery disease severity on long-term outcomes in unprotected left main coronary artery
Serkan Kahraman1, Hicaz Zencirkiran Agus1, Gökhan Demirci1
1Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, İstanbul, Turkey.
Insights
Coronary artery disease severity predicts outcomes after left main coronary artery percutaneous coronary intervention (PCI). Higher SYNTAX scores and residual SYNTAX scores indicate increased risk of adverse cardiovascular events and mortality.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Clinical Research
Background:
- Optimal treatment for left main coronary artery (LMCA) disease remains debated.
- Percutaneous coronary intervention (PCI) is an alternative to surgery for LMCA disease.
- Understanding long-term prognostic factors is crucial for patient management.
Purpose of the Study:
- To identify long-term prognostic determinants in patients undergoing LMCA PCI.
- To evaluate the impact of coronary artery disease (CAD) severity on outcomes after LMCA PCI.
- To assess the role of SYNTAX scores in predicting adverse events.
Main Methods:
- Sixty patients undergoing LMCA PCI were analyzed.
- Baseline clinical data, SYNTAX score (SS), SS II, and residual SS (rSS) were recorded.
- Primary endpoints included all-cause death, myocardial infarction (MI), and stroke.
Main Results:
- A composite endpoint occurred in 26.7% of patients over a median follow-up of 25 months.
- Higher initial SS, SS II, and rSS were associated with composite endpoints.
- Creatinine, non-postdilatation, and rSS were independent predictors of adverse outcomes.
Conclusions:
- CAD severity, assessed by initial and residual SYNTAX scores, is a significant prognostic factor after unprotected LMCA PCI.
- Increased rSS independently predicts major adverse cardiac and cerebrovascular events and mortality.
- These findings aid in risk stratification and treatment decisions for LMCA disease.
Objective:
The optimal treatment modality for left main coronary artery (LMCA) disease is still controversial. The aim of this study was to investigate long-term prognostic determinants of percutaneous coronary intervention (PCI) for LMCA disease and the role of coronary artery disease (CAD) severity in this population.
Methods:
A total of 60 consecutive patients who underwent LMCA PCI were enrolled in this study. Baseline demographic and clinical variables were recorded, as well as the SYNTAX score (SS), SS II, and residual SS (rSS). The primary endpoints of the study were all-cause death, non procedural myocardial infarction (MI), and stroke. The patients were then divided into 2 groups: patients without a composite endpoint (Group 1) and those with a composite endpoint (Group 2).
Results:
Of the 60 patients, 15 (25%) were female and the mean age was 59.8±14.7 years. The median follow-up time was 25 months (range: 12-33 months). A primary composite endpoint was observed in 16 patients (26.7%): mortality occurred in 10 patients (16.7%), 4 (6.6%) experienced MI, and stroke was seen in 2 patients (3.3%). Target vessel revascularization was performed in 3 patients (5%). The mean SYNTAX score (Group 1: 19.9±9.8; Group 2: 26.8±12.2; p=0.029), SS II PCI (Group 1: 27.7 [range: 17.7-36.8]; Group 2: 34.2 [range: 27.9-55.2]; p=0.030) and rSS (Group 1: 0 [range: 0-5]; Group 2: 12.5 [range: 3.5-22.5]; p=0.001) were higher in patients with a composite endpoint. Additionally, creatinine (odds ratio [OR]: 13.098; 95% confidence interval [CI]: 1.471-116.620; p=0.021), non-postdilatation (OR: 8.340; 95% CI: 1.230-56.570; p=0.030), and rSS (OR: 1.157; 95% CI: 1.024-1.307; p=0.019) were independent predictors of a primary composite endpoint.
Conclusion:
CAD severity has prognostic value for mortality, MI, and stroke in patients who undergo unprotected LMCA PCI. An increased initial SS and post-procedural rSS were related to adverse cardiovascular outcomes. The rSS was also an independent predictor of major adverse cardiac and cerebrovascular events and mortality.
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