Author + information
- Ignacio Sanchez-Perez1,
- Jesus Piqueras-Flores2,
- Alfonso Jurado1,
- María Thiscal López Lluva1,
- Natalia Pinilla-Echeverri3,
- Andrea Moreno-Arciniegas1,
- Manuel Marina-Breysse1 and
- Fernando Lozano1
Nowadays, current practice guidelines do not recommend a percutaneous coronary intervention (PCI) treatment for complex anatomical coronary lesions (Syntax score ≥ 32) that involve left main coronary artery (LMCA). Nevertheless, PCI could be of choice in selected surgical high-risk patients. The main objective of this study was to evaluate the efficacy and safety of PCI in LMCA disease with high Syntax score at 10 years follow-up.
We prospectively included 123 consecutive patients (71 ± 11 years, 70.5% male) with LMCA disease and Syntax score ≥ 32 treated with PCI between June 2006 and April 2015. We evaluated the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after a 10 year clinical follow-up (median 40.8 months).
44.7% of patients had stable coronary disease and 55.3% acute coronary syndrome (35% Non-STEMI and 20.3% STEMI). 45% were diabetic patients and 45.1% presented moderate-severe left ventricular systolic dysfunction. 45% of patients had logistic EuroSCORE ≥ 12% and median Syntax score was 41.5. The most frequent bifurcation technique employed in LMCA was “provisional stenting” in 64.2% of cases, and zotarolimus eluting stent was used in 71.1% of cases. Stroke rate after PCI was 0.9%. During follow-up, MACE rate at 10 years was 15.3% (10.3% cardiac death, 0.9% non-fatal myocardial infarction, 4.9% TLR and thrombosis rate 0%). We observed significant differences in the occurrence of TLR in patients in which double stent bifurcation techniques were used (1.5% vs 10%, p=0.05). 25.7% of patients had an angiographic follow-up.
PCI treatment of LMCA disease and high Syntax score (≥ 32) in surgical high-risk patients provide very positive results and low rate of major cardiac adverse events at a long-term follow-up. Double stent bifurcation techniques at LMCA were associated with a higher TLR rate.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)