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

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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