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In-hospital outcomes of ad hoc versus planned PCI for unprotected left-main disease: An analysis of 8574 cases from

Tim Kinnaird1, Sean Gallagher1, Vasim Farooq1

  • 1Department of Cardiology, University Hospital of Wales, Cardiff, UK.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 5, 2024
PubMed

Insights

Ad hoc unprotected left main stem PCI (uLMS-PCI) is linked to worse in-hospital outcomes than planned procedures. These findings highlight the need for careful procedural planning in uLMS-PCI cases.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Existing data suggests similar outcomes for ad hoc versus planned percutaneous coronary intervention (PCI) in general.
  • However, specific data regarding ad hoc unprotected left main stem PCI (uLMS-PCI) outcomes is limited.

Purpose of the Study:

  • To compare in-hospital outcomes between ad hoc and planned uLMS-PCI procedures.
  • To identify potential differences in procedural characteristics and complications.

Main Methods:

  • Retrospective analysis of UK patients undergoing uLMS-PCI between 2006-2018.
  • Exclusion of patients with ST-segment elevation myocardial infarction, cardiogenic shock, or emergency PCI indications.
  • Comparison of outcomes between ad hoc and planned PCI groups.

Main Results:

  • Out of 8574 uLMS-PCI procedures, 33.1% were performed ad hoc.
  • Ad hoc PCI was associated with less intervention for stable angina and more potent P2Y12 inhibitor use.
  • Higher rates of acute procedural complications (slow flow, dissection, shock induction) and in-hospital adverse events (death, MACE) were observed in the ad hoc group.

Conclusions:

  • Ad hoc uLMS-PCI is associated with increased risks of procedural complications and adverse in-hospital outcomes compared to planned uLMS-PCI.
  • These findings underscore the importance of strategic planning for uLMS-PCI procedures.
Abstract

Keywords:
left main arterynational databasepercutaneous coronary interventionad hoc PCI

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