Author + information
- Ignacio Sanchez-Perez1,
- Jesus Piqueras-Flores1,
- Alfonso Jurado-Román1,
- María Thiscal López Lluva1,
- Natalia Pinilla-Echeverri2,
- Ramón Maseda Uriza1,
- 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-year follow-up.
We prospectively included 136 consecutive patients (71.9 ± 10.5 years, 75.7% male) with LMCA disease and Syntax score ≥ 32 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 40.8 months).
44.9% of patients had stable coronary disease and 55.9% acute coronary syndrome (42.7% Non-STEMI and 13.2% STEMI). 45.5% were diabetic patients and 46.5% presented moderate-severe left ventricular systolic dysfunction. Mean logistic EuroSCORE was 8.02% and median Syntax score was 48.7. The most frequently bifurcation technique employed in LMCA was “provisional stenting” in 61.9% of cases, and zotarolimus eluting stent was used in 73.3% of cases. Stroke rate after PCI was 0.7%. During follow-up, MACE rate at 10 years was 16.9% (11.8% cardiac death, 0.9% non-fatal myocardial infarction, 6.7% TLR and thrombosis rate 0%). The predictors of MACE were kidney insufficiency, Killip 3-4, use of first generation drug eluting stents (DES), double stent techniques, no final kissing balloon and left ventricular dysfunction. TLR rate was significantly higher in patients treated with double stent bifurcation techniques and patients treated with first generation DES. 25% 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 mayor cardiac adverse events at a very long-term follow-up. Two stents bifurcation technique and first generation DES were associated with a higher TLR rate.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)