Author + information
- Ignacio Sanchez-Perez1,
- Jesus Piqueras-Flores1,
- Fernando Lozano1,
- María Thiscal López Lluva1,
- Natalia Pinilla-Echeverri2,
- Ramón Maseda Uriza1 and
- Alfonso Jurado-Román1
The progressive aging of the population leads to higher prevalence of ischemic heart disease with an increased left main coronary artery (LMCA) disease. Elderly patients (>75 years) represent an unfavorable subgroup because of their fragility and high rate of surgical risk. The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary interventions (PCI) in LMCA disease at 10-year follow-up in the elderly.
We prospectively included 145 consecutive patients (81.5 ± 2.4 years, 65.5% male) with LMCA disease treated with PCI between June 2006 and April 2016. We evaluated the presence of major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after 10 years clinical follow-up (median 47.4 months).
45.6% of patients had stable coronary disease and 54.4% acute coronary syndrome (45.4% Non-STEMI and 9% STEMI). 42.8% were diabetic patients and 42.7% presented moderate-severe left ventricular systolic dysfunction. Mean logistic EuroSCORE was 10.3% and 40.7% Syntax score ≥ 32. The most frequently bifurcation technique employed was “provisional stenting” in 64.5% of cases, and second generation drug eluting stent was used in 89.3% of cases. The intraprocedural complication rate was 3.5% with one death. During follow-up, MACE rate at 10 years was 19.3% (15.2% cardiac death, 0.9% non-fatal myocardial infarction, 4% TLR and thrombosis rate 0.9%). There were significant differences in the occurrence of MACE in patients without final “kissing balloon” (p=0.02) and patients with ventricular dysfunction (p=0.001).
In elderly patients with high surgical risk, left main PCI provide very favourable results with a low rate of immediate complications in the procedure and low rate of cardiac adverse events at a very long-term follow-up. However, patients with ventricular dysfunction have poor prognosis.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)