Predictors of 30-day and 12-month mortality in left main stem percutaneous coronary intervention 2016-2020: A study
Elliott J Carande1, Majd B Protty2, Sarah Verhemel3
1Department of Cardiology, Morriston Cardiac Centre, Swansea, UK.
Insights
Outcomes for left main stem percutaneous coronary intervention (LMS-PCI) show that older age and pre-procedure shock increase 30-day mortality. Twelve-month mortality is linked to older age, acute coronary syndrome, renal disease, and shock.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- Left main stem percutaneous coronary intervention (LMS-PCI) is an alternative to coronary artery bypass graft (CABG) for select patients.
- Real-world data on LMS-PCI outcomes are limited, necessitating further investigation.
- Current guidelines support PCI for unprotected LMS disease in low SYNTAX score patients.
Purpose of the Study:
- To quantify mortality rates following LMS-PCI.
- To identify predictors of 30-day and 12-month mortality after LMS-PCI.
- To analyze contemporary real-world outcomes of LMS-PCI.
Main Methods:
- Retrospective analysis of 484 LMS-PCI cases from two UK centers (2016-2020).
- Descriptive statistics to summarize patient and procedural characteristics.
- Multivariate logistic regression to determine predictors of 30-day and 12-month mortality.
Main Results:
- Overall 30-day mortality was 9.5% and 12-month mortality was 16.7%.
- Predictors of 30-day mortality included older age and pre-procedure shock.
- Predictors of 12-month mortality included older age, acute coronary syndrome, renal disease, and pre-procedure shock.
Conclusions:
- Older age and cardiogenic shock are associated with increased short-term mortality after LMS-PCI.
- Long-term mortality is influenced by older age, ACS, renal disease, and cardiogenic shock.
- Elective LMS-PCI procedures demonstrated significantly lower mortality rates.
Introduction:
Left main stem percutaneous coronary intervention (LMS-PCI) is a complex high-risk procedure which can be performed as an alternative to coronary artery bypass graft (CABG) procedure in surgical turn-down patients or where there is equipoise in percutaneous versus surgical strategies. Current guidelines suggest that PCI is an appropriate alternative to CABG in patients with unprotected LMS disease and low SYNTAX score. However, "real world" data on outcomes of LMS-PCI remain limited. This study aims to quantify and determine predictors of mortality following LMS-PCI.
Methods:
Using local coronary angioplasty registries from two UK centers, all LMS-PCI cases were identified from 2016 to 2020. Descriptive statistics and multivariate logistic regressions were used to examine the association between baseline and procedural characteristics with 30-day and 12-month mortality.
Results:
We identified 484 cases of LMS-PCI between 2016 and 2020. There was a year-on-year increase in the number of LMS-PCI, the highest being in 2020. Covariates associated with higher 30-day mortality were age (OR 1.07, 95% CI: 1.02-1.12) and shock preprocedure (OR 23.88, 95% CI: 7.90-72.20). Covariates associated with higher 12-month mortality were age (OR 1.04, 95% CI: 1.01-1.08), acute coronary syndrome (ACS) (OR 2.50, 95% CI: 1.08-5.80), renal disease (OR 5.24, 95% CI: 1.47-18.68), and shock preprocedure (OR 7.93, 95% CI: 3.30-19.05). Overall, 30-day and 12-month mortality in this contemporary data set were 9.5% and 16.7%, respectively, with significantly lower rates in elective cases (p < 0.01).
Conclusions:
Older age and cardiogenic shock preprocedure were associated with increased 30-day mortality after LMS-PCI. Twelve-month mortality was associated with older age, ACS presentation, preexisting renal disease, and cardiogenic shock preprocedure.
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