PhD Scientific Days 2023

Clinical Medicine I.

Five-year outcome of unprotected left main percutaneous coronary interventions: a single tertiary-care centre experience

Text of the abstract

Introduction: Randomized studies on patients with unprotected left main coronary artery disease (ULMCA) involve highly selected populations therefore their conclusions have limited generalizability.
Aims: To investigate the 60-month mortality and event-free survival of consecutive patients undergoing ULMCA percutaneous coronary intervention (PCI) at our center. We aimed to determine the independent predictors of and the best risk score system to predict event-free survival.
Methods: All patients who underwent ULMCA PCI at our centre between 1 January 2010 and 30 June 2014 were included. No exclusion criterion was applied. Patients were divided in elective and acute groups. The endpoint of the study was the composite of all-cause mortality, myocardial infarction, and target lesion revascularization at 60 months.
Result: A total of 325 patients (mean age 68 ± 12 years, 65% male), 110 (34%) elective and 215 (66%) acute patients underwent ULMCA PCI during this period. The mean survival (50.1 vs. 41 months, p=0.006) and event-free survival (46.2 vs. 33 months, p=0.001) of elective patients were significantly higher than those of acute patients. There was no significant difference between the groups in terms of survival (52.2 vs. 51.2 months, p=0.497) or event-free survival (48.1 vs. 43.3 months, p=0.075) among those who survived the first 30 days without any event. Of the risk scores, the SYNTAX II score was the most predictive both in elective (AUC=0.759) and acute patients (AUC=0.790), whereas the SYNTAX score was the least predictive (elective AUC=0.571, acute AUC=0.641). Age (HR 1.038; 95% CI 1.005-1.072, p=0.022 and HR 1.029; CI 1.011-1.048, p=0.002) and left ventricular function (HR 2.460; CI 1.230-4.923, p=0.011 and HR 2,141; CI 1.341-3.418, p=0.001) were independent predictors of events both in elective and acute patients, respectively. Renal function (HR 3.015; CI 1.981-4.587, p<0.001), diabetes mellitus (HR 1.645; CI 1.105-2.450, p=0.014) and previous myocardial infarction (HR 1.849; CI 1.215-2.815, p=0.004) were independent predictors of event-free survival among acute patients only.
Conclusion: ULMCA PCI has favorable long-term outcome. In terms of mortality, the first 30 days are critical in acute patients, after that, survival and event-free survival are similar in acute and elective ULMCA patients undergoing PCI.
Funding: None.