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Resumen Antecedentes: El mejor método para el tratamiento de la revascularización de la lesión del tronco no protegido de la coronaria izquierda es un tema de creciente interés. Método: Se realizaron un total de 2,439 intervenciones coronarias percutáneas (ICP) durante 3 años; se incluyeron los pacientes con lesión del tronco no protegido de la coronaria izquierda (TCI; n = 48) y se compararon con pacientes a los que se realizó cirugía de revascularización coronaria (CRVC; n = 50). Se analizaron los eventos cardiovasculares en fase hospitalaria y extrahospitalaria. El promedio de seguimiento fue de 16 meses. Resultados: El riesgo cardiovascular fue mayor en pacientes con ICP; log EuroSCORE (16 ± 21 vs. 5 ± 6, p = 0.001), Syntax clínico (77 ± 74 vs. 53 ± 39, p = 0.04). Los pacientes del grupo de ICP presentaron al ingreso con más frecuencia infarto con elevación del ST (IMCEST) y con choque cardiogénico. Los eventos hospitalarios fueron similares en ICP y CRVC (14% vs. 18%, p = 0.64). El IMCEST fue menos frecuente en el grupo de ICP (0% vs. 10%, p = 0.03. Los eventos cardiovasculares fueron menores en el grupo de ICP (2.3% vs. 18%, p = 0.01) y hubo una disminución de la muerte general y cardiaca (2.3% vs. 12%, p = 0.08 y 2.3% vs. 8%, p = 0.24), al excluir los pacientes con choque cardiogénico como presentación. En la fase extrahospitalaria los eventos fueron similares en ICP y CRVC (15% vs. 12%, p = 0.46). La supervivencia sin eventos cardiovasculares, muerte general y cardiaca fueron comparables entre los grupos (log rank, p = 0.38, p = 0.44 y p = 0.16). Conclusión: Pese a que los pacientes de ICP mostraron un perfil de riesgo mayor que los de CRVC, la seguridad y eficacia intrahospitalaria y extrahospitalaria fueron similares. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Abstract Background: The best revascularisation method of the unprotected left main artery is a current and evolving topic. Methods: A total of 2439 percutaneous coronary interventions (PCI) were registered during a 3-year period. The study included all the patients with PCI of the unprotected left main coronary (n = 48) and matched with patients who underwent coronary artery bypass graft (CABG) (n = 50). Major adverse cerebral and cardiac events (MACCE) were assessed within the hospital and in outpatients during a 16 month follow up. Results: The cardiovascular risk was greater in the PCI group; logEuroSCORE 16 ± 21 vs. 5 ± 6, P = .001; clinical Syntax 77 ± 74 vs 53 ± 39, P = .04. On admission, the PCI group of patients had a higher frequency of ST segment elevation myocardial infarction (STEMI) and cardiogenic shock. The MACCE were similar in both groups (14% vs. 18%, P = .64). STEMI was less frequent in the PCI group (0% vs. 10%, P = .03). Cardiovascular events were lower in the PCI group (2.3% vs. 18%, P = .01), and there was a decrease in general and cardiac mortality (2.3% vs. 12%, P = .08 y 2.3% vs. 8%, P = .24), on excluding the patients with cardiogenic shock as a presentation. MACCE were similar in both groups in the out-patient phase (15% vs. 12%, P = .46). Survival without MACCE, general and cardiac death were comparable between groups (log rank, P = .38, P = .44 and P = .16, respectively). Conclusion: Even though the clinical and periprocedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Subject(s)
Humans , Male , Female , Aged , Coronary Artery Disease/surgery , Coronary Artery Bypass , Percutaneous Coronary Intervention/methods , Time Factors , Case-Control Studies , Retrospective Studies , Longitudinal Studies , Treatment Outcome , MexicoABSTRACT
Objective To study the prognosis and risk factors of senile patients with unprotected left main coronary artery (ULMCA) disease treated with PCI.Methods Patients with ULMCA undergoing PCI from a single center were enrolled in the study.All patients were older than 60.The baseline characteristics were collected and the prognosis and risk factors of the patients were followed-up.All the major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated throughout the follow-up period.Based on those data,Kaplan-Meier curves were plotted and Cox multivariate regression analysis was performed to assess the prognosis and identify risk factors.Results A total of 182 consecutive patients were recruited and followed up with a mean follow-up time of 21.5 (13,36.5) months and an estimated median MACCE-free survival time of 66 months by K-M method.During the follow up,all-cause mortality,non-fatal myocardial infarction,non-fatal cerebrovascular events and target vessel revascularization rates were 6.59％,0.55％,0.55％ and 15.93％ respectively,the incidence of all MACCE was 23.63％.A percentage of 72.09 of the MACCEs had occurred in the first 2 years after the PCI.According to the multivariate-adjusted Cox regression analysis,diameter of left main stent (HR =0.37,95％ CI:0.17-0.82,P =0.014),bifurcation lesion (HR =1.92,95％ CI:1.O1-3.62,P =0.045),smoking index ＞ 50pack / year (HR =3.78;95％ CI:1.29-11.05,P =0.015) were the independent risk factors of MACCE.EuroSCORE Ⅱ ≥2％ (HR =3.96,95％ CI:1.15-13.61,P =0.029) was the independent risk factor of all-cause death.Conclusion The prognosis of PCI-treated ULMCA disease is generally favorable.Most MACCEs occurred in the first 2 years after the PCI.Small left main stents diameter,bifurcation lesions,smoking index ＞ 50 pack/year and EuroSCORE Ⅱ ≥2％ were the risk factors for poor prognosis in patients with ULMCA disease.
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<p><b>INTRODUCTION</b>Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) disease is clinically catastrophic although it has a low incidence. Studies on the long-term prognosis of these patients are rare.</p><p><b>METHODS</b>From January 1999 to September 2013, 55 patients whose infarct-related artery was the ULMCA were enrolled. Clinical, angiographic and interventional data was collected. Short-term and long-term clinical follow-up results as well as prognostic determinants during hospitalisation and follow-up were analysed.</p><p><b>RESULTS</b>Cardiogenic shock (CS) occurred in 30 (54.5%) patients. During hospitalisation, 22 (40.0%) patients died. Multivariate logistic regression analysis showed that CS (odds ratio [OR] 5.86; p = 0.03), collateral circulation of Grade 2 or 3 (OR 0.14; p = 0.02) and final flow of thrombolysis in myocardial infarction (TIMI) Grade 3 (OR 0.05; p = 0.03) correlated with death during hospitalisation. 33 patients survived to discharge; another seven patients died during the follow-up period of 44.6 ± 31.3 (median 60, range 0.67-117.00) months. The overall mortality rate was 52.7% (n = 29). Kaplan-Meier analysis showed that the total cumulative survival rate was 30.7%. Cox multivariate regression analysis showed that CS during hospitalisation was the only predictor of overall mortality (hazard ratio 4.07, 95% confidence interval 1.40-11.83; p = 0.01).</p><p><b>CONCLUSION</b>AMI caused by ULMCA lesions is complicated by high incidence of CS and mortality. CS, poor collateral blood flow and failure to restore final flow of TIMI Grade 3 correlated with death during hospitalisation. CS is the only predictor of long-term overall mortality.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Angiography , Angioplasty, Balloon, Coronary , Coronary Artery Disease , Pathology , Therapeutics , Coronary Vessels , Pathology , Follow-Up Studies , Hospitalization , Kaplan-Meier Estimate , Multivariate Analysis , Myocardial Infarction , Diagnosis , Therapeutics , Odds Ratio , Percutaneous Coronary Intervention , Prognosis , Proportional Hazards Models , Regression Analysis , Retrospective Studies , Shock, CardiogenicABSTRACT
Objective To evaluate the long-term prognostic capacity of the SYNTAX score Ⅱ(SxScore Ⅱ) and SYNTAX score (SxScore) in patients undergoing left main percutaneous coronary intervention (LM-PCI). Methods A total of 209 patients undergoing unprotected LM-PCI in the Cardiology Department of the Affiliated Hospital of PAP of Logistic College were prospectively collected. Follow up was carried out by telephone or outpatient or rehospitalization. The clinical endpoint focused on MACCE after PCI including composite death, nonfatal myocardial infarction, target vessel revascularization and stroke. The secondary endpoint included cardiac death and stent thrombosis. The SxScore and SxScoreⅡ were retrospectively calculated according to results of coronary angiography and clinical features of patients. Patients were stratified according to tertiles of low (≤22), intermediate (23-32), and high (≥33). The clinical data were comparedbetween three groups. The predictive ability of two scoring systems to MACCE after PCI was compared by COX regression evaluation. Results In 209 patients, 12 patients were lost to follow-up (5.7%), and the median follow-up was 30.2 months, 56 cases (28.4%) were observed to suffer from MACCE. The incidence rates of MACCE were 19.0%, 28.6%and 44.4%in SxScore low, intermediate and high groups respectively. The incidence rates of MACCE were 12.8%, 23.8%and 45.5%in SxScoreⅡlow, intermediate and high groups respectively. Single factor analysis showed that SxScore, SxScoreⅡ, age, diabetes and left ventricular ejection fraction (LVEF) were the independent predictors of MACCE. Multivariate analysis showed that SxScore and SxScoreⅡwere still risk independent predictors for MACCE. Conclusion Both SxScore and SxScoreⅡare independent risk predictors for MACCE in patients with unprotected left main coronary artery disease undergoing PCI treatment.
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Objective To compare the incidence of MACE and predictors in patients with unprotected left main coronary artery disease (ULMCAD) after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). To establish a risk stratification to guide treatment and prognosis of patients with ULMCAD who underwent PCI. Methods The incidence of MACE in 201 patients with ULMCAD who underwent PCI or CABG was compared, retrospectively. The predictors of MACE of the two groups were obtained by logistic regression analyses. The predictors of MACE of the PCI group were assigned and stratified. The validity of the risk stratification on the prediction of MACE was verified in a new group of 126 patients with ULMCAD who underwent PCI. Results The incidence of MACE of PCI and CABG group was 16% and 11.9%, respectively. Logistic regression analyses showed that LVEF, diabetes mellitus and Syntax score were related to MACE in PCI group, while age, LVEF and renal function insufficiency were related to MACE in CABG group. The verification results showed a good predictive value of the risk stratification based on LVEF, diabetes mellitus and Syntax score on the incidence of MACE. Conclusions PCI treatment in patients with ULMCAD is feasible and has a good long-term outcome. The risk stratification in accordance with LVEF, diabetes mellitus and Syntax score has good predictive value on the incidence of MACE.
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Coronary-artery bypass grafting(CABG)has been a standard treatment for unprotected left main coronary artery disease.Advancement in percutaneous coronary intervention(PCI)makes PCI as effective as CABG in selected patients.In this study,we assess the optimal revascularization strategy for patients with unprotected left main coronary artery disease.