Author + information
- Ignacio Sanchez-Perez1,
- Jesus Piqueras-Flores1,
- Fernando Lozano1,
- María Thiscal López Lluva1,
- Natalia Pinilla-Echeverri2,
- Ramón Maseda Uriza1 and
- Alfonso Jurado-Román1
Left main coronary artery (LMCA) disease is encountered in approximately 6% of coronary angiograms and in 4% of acute coronary syndromes (ACS). The survival of patients with LMCA disease presenting with acute ACS it's lowest in those with cardiogenic shock. Percutaneous coronary intervention (PCI) in ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) due to LMCA disease were not been sufficiently studied. The main objective of this study was to evaluate the efficacy and safety of PCI in patients with concomitant LMCA disease and ACS at a long-term follow-up.
We prospectively included 178 consecutive patients (70.1 ± 10.5 years, 71.9% male) with concomitant LMCA and ACS disease treated with PCI between June 2006 and April 2016. 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 10-year clinical follow-up (median 56 months).
80.9% of patients were presented as NSTEMI and 19.1% as STEMI. 42.7% were diabetic patients and 23.3% had Killip class 3-4 at presentation. An intra-aortic balloon pump was needed in 11.2% of the cases and thromboaspiration was required in 9.3% of cases. The most frequently bifurcation technique employed in LMCA was “provisional stenting” in 67.6% of cases and final “kissing balloon” was done in 59.4% of procedures. We implant zotarolimus eluting stent in 77% of patients and complication rate in the procedure was 1.3%. Global rate of in-hospital mortality was 6.7%. During follow-up, MACE rate at 10 years was 18.8% (13.6% cardiac death, 1.3% nonfatal myocardial infarction, 5.2% TLR and thrombosis rate 0%). We observed significant differences in the occurrence of MACE in patients with STEMI (p=0.03), moderate-severe left ventricular systolic dysfunction (p=0.001), Killip class 3-4 at presentation (p<0.001) and patients treated with first generation of drug eluting stents (p=0.02).
Patients treated with PCI in ACS concomitant with LMCA disease presents higher in-hospital mortality. Those patients who get to be discharged from the hospital have very favourable results with a low rate of mayor cardiac events at very long-term follow-up.
CORONARY: Acute Coronary Syndromes