TCT-79 Unprotected Left Main PCI in Focus: Procedural Insights, Clinical Outcomes, and Predictors of Mortality in a High-Volume Quaternary Care Center

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Keywords

adult, aged, all cause mortality, assisted circulation, cardiogenic shock, Caucasian, clinical outcome, cohort analysis, complication, conference abstract, controlled study, coronary artery bypass graft, coronary artery bypass surgery, drug therapy, female, heart infarction, heart left ventricle ejection fraction, heart surgery, high risk patient, human, left coronary artery, major clinical study, male, mortality, mortality rate, non ST segment elevation myocardial infarction, percutaneous coronary intervention, retrospective study, ST segment elevation myocardial infarction, stable angina pectoris, survival rate, SYNTAX score, therapy, unstable angina pectoris

Abstract

Background: Unprotected left main coronary artery percutaneous coronary intervention (ULMCA-PCI) presents a unique therapeutic challenge, with conflicting data on short and long-term outcomes. Coronary artery bypass grafting (CABG) remains the guideline-preferred treatment approach. Methods: We performed a retrospective cohort review of patients undergoing ULMCA-PCI at a quaternary care institute in Metropolitan Detroit from 2019 to 2023. Complication rates and outcomes including in-hospital, 30-day, 90-day, and 1-year all-cause mortality were assessed. Subgroup analysis was performed on patients with high Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) scores, defined as ≥33. Results: 626 patients were analyzed, the majority of whom were male (67.6%) and white (63.3%), with a median (Q1-Q3) age of 73 (65-80). LMCA-PCI indications included stable angina (41.9%), unstable angina (17.1%), non–ST-segment myocardial infarction (NSTEMI, 32.1%), STEMI (4.5%), and acute MI–related cardiogenic shock (AMI-CS, 4.5%). Median SYNTAX score was 27.0 (25.0-31.0), with 130 (20.7%) patients having a score ≥33. Mechanical circulatory support (MCS) was utilized electively in 84 (13.4%) of cases. Successful revascularization was achieved in 623 (99.5%) of cases. Complications occurred in 125 (19.9%) of cases when assessed as a composite. 120 subjects (19.2%) required emergency escalation of MCS intraoperatively, and 74 (10.1%) required continuation of MCS postoperatively. All-cause in-hospital mortality rate was 6.1%. 30-day, 90-day, and 1-year survival rates were 91.9%, 90.7%, and 84.3%, respectively. Patients with a high SYNTAX score (≥33) experienced similar complication rates overall but had notably higher rates of perforations (P = 0.02) and higher MCS use (P = 0.041). Despite this, a higher SYNTAX score correlated with greater left ventricular ejection fraction improvement at 1 year (R = 0.201; P = 0.006). Conclusions: Our study results, in conjunction with the evolving data on the viability of ULMCA-PCI, provide a foundation for future research aimed at a more in-depth comparison between PCI and CABG within this high-risk patient cohort. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP).

Volume

84

Issue

18

First Page

B202

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