026 Immediate and long term outcomes after unprotected left main coronary artery angioplasty

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• 作者：Sofiene Rekik ; Jerome Brunet ; Francois Xavier Hager ; Gilles Bayet ; Laurent Meille ; Jean Michel Quatre ; Joel Sainsous
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2011
• 出版时间：January 2011
• 年：2011
• 卷：3
• 期：1
• 页码：9
• 全文大小：65 K

文摘

Background

Although cardiac surgery is still considered as the gold standard of care for patients with unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) is emerging as a possible alternative.

Aim

To evaluate immediate and long term outcomes of PCI in an unselected cohort of patients with ULMCA disease.

Methods

246 consecutive patients who underwent ULMCA angioplasty in a single high volume centre over a 5-year period were included. Major adverse cardiac events were defined as a combined end point of cardiac death, non fatal myocardial infarction (MI), or target lesion revascularisation (TLR). 2 sided p values<0.05 were considered statistically significant.

Results

Mean age was 72.5 ¡À 11.3. 185 patients (75.2 % ) were males; 60 (24.4 % ) had diabetes mellitus and 62 (25.2 % ) had peripheral artery disease. Mean additive EuroSCORE value was 7.1 ¡À 4.5 and mean predicted surgical mortality by logistic EuroSCORE was 14 % .

For distal LM lesions (56 % ), the provisional side-branch T-stenting approach was used in 81 % of cases and final kissing balloon inflation in 92 % . DES were used in 32 % of cases. Angiographic success was obtained in 99.6 % of cases. In hospital mortality was 1.6 %

After a mean follow up of 30.42 months, rates of cardiac deaths, TLR and MACE were respectively 8.5 % (21 cases), 11 % (27 cases) and 19.9 % (48cases).

On multivariate analysis, EuroSCORE >6 was the only independent predictor of cardiac death (HR = 3.1 95 % IC [1.2?.3], p = 0.028); predictors of MACE were EUROSCORE>6 (HR = 1.95 95 % IC [1.05?.6], p = 0.032) and distal LM lesions (HR = 2.02, 95 % IC [1.04?.9], p = 0.037).Conversely, neither initial clinical presentation nor stent type affected outcome.

Conclusion

ULMCA stenting with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good long term clinical outcomes. Long term predictors of death were Euro-SCORE values>6 and distal LM lesion.