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Percutaneous coronary intervention in unprotected left main coronary artery stenosis: Mid-term outcomes of a
Prathap Kumar N1, Stalin Roy2, Manu Rajendran2
1Chief Interventional Cardiologist, Department of Cardiology, Meditrina Hospital, Kollam, Kerala, India.
Insights
Percutaneous coronary intervention (PCI) using drug-eluting stents (DES) is a safe and effective treatment for unprotected left main coronary artery (ULMCA) disease. This study shows acceptable in-hospital and mid-term outcomes for ULMCA PCI in Indian patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) is an alternative to coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) disease.
- PCI is suitable for patients with low-to-intermediate complexity or those who refuse CABG.
Purpose of the Study:
- To assess the safety and outcomes of ULMCA stenting with drug-eluting stents (DES).
- To evaluate in-hospital and mid-term results in Indian patients.
Main Methods:
- Retrospective analysis of 661 patients undergoing ULMCA PCI between March 2011 and February 2020.
- Primary outcome: composite of major adverse cardiovascular and cerebrovascular events (MACCE).
- Median follow-up: 2.8 years.
Main Results:
- In-hospital MACCE incidence: 1.8%.
- Follow-up MACCE incidence: 11.5% (8.4% cardiac deaths).
- Overall survival rates at 1, 3, 5, and 9 years: 94%, 88%, 84%, and 82% respectively.
- Independent predictors of mortality: age >65 years and high SYNTAX scores.
Conclusions:
- ULMCA PCI with DES demonstrates safety and acceptable outcomes.
- This approach is suitable for patients with low-to-intermediate SYNTAX scores.
Background:
Percutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected left main coronary artery (ULMCA) disease in patients with low-to-intermediate anatomic complexity or when the patient refuses CABG even after adequate counselling by heart team. We assessed the safety, in-hospital and mid-term outcomes of ULMCA stenting with drug-eluting stents (DES) in Indian patients.
Methods:
Our study was a retrospective analysis of patients who had undergone ULMCA PCI at a tertiary center, between March 2011 and February 2020. Clinical characteristics, procedural data, and follow-up data were analyzed. The primary outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospital stay and at follow-up. The median follow-up was 2.8 years (interquartile range: 1.5-4.1 years).
Results:
661 patients (mean age, 63.5 ± 10.9 years) had undergone ULMCA PCI. The mean SYNTAX score was 27.9 ± 10.4 and the mean LVEF was 58.0 ± 11.1%. 3-vessel disease and distal lesions were noted in 54% and 70.6% patients, respectively. The incidence of in-hospital MACCE was 1.8% and the MACCE during follow-up was 11.5% (including 48 [8.4%] cardiac deaths). The overall survival rates after one, three, five, and nine years were 94%, 88%, 84%, and 82%, respectively. The multivariate analysis revealed that age >65 years and high SYNTAX scores were independent predictors of mid to long-term mortality.
Conclusion:
ULMCA PCI with DES is safe and has acceptable in-hospital and mid-term outcomes among patients with low-to-intermediate SYNTAX score.
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