Bifurcation/Left Main Diseases and Intervention
Clinical Characteristics and Outcomes of Left Main Coronary Artery (LMCA) Percutaneous Coronary Intervention (PCI): 1-Year Data from a Single Centre Without On-site Cardiothoracic Service
Yew Fung Kwan1, Tze Ming Chan1, Ramachandran Sathappan1, Benjamin Tao Xiung Lim1, Jian-Chen Lim1, Hameeth Shah Abdul Wahid1, Gurpreet Pal Singh Jugindar Singh1, Mohd Ruslan Mustapa1, Hazleena Mohamed Hasnan1, Nor Hanim Mohd Amin1
Hospital Raja Permaisuri Bainun, Malaysia1
LMCA PCI carries higher major adverse cardiac events (MACE) rate especially in patients with high SYNTAX score in which coronary artery bypass graft (CABG) offers more benefits.
A retrospective, single-centre study on patients who underwent LMCA PCI from 1 October 2019 until 30 September 2020. Clinical characteristics of patients were analysed, which included epidemiology, left ventricular ejection fraction (LVEF), cardiovascular (CV) risk factors, baseline renal function, operator experience, SYNTAX score, contrast usage and LMCA bifurcation PCI technique. Outcomes of 30-day MACE (all-cause death, cardiac death or myocardial infarction) were evaluated based on clinical characteristics.
Total 30 patients were included. Mean age was 58.9 ± 10.9 years. Most of the patients were male (n = 25, 83.3 %). Mean LVEF was 46.6 ± 10.9 %. Most of them (n = 12, 40.0 %) had normal left ventricular (LV) function (LVEF ≥ 50 %) and only 1 patient (3.3 %) had severely impaired LV function (LVEF < 30 %). In terms of CV risk factors, 43.3 % were smokers, 56.7 % had diabetes mellitus, 70.0 % had hypertension, 43.3 % had dyslipidaemia and 10.0 % had end stage renal disease. The majority of patients (n = 22, 73.3 %) were elective cases, and the remaining 8 patients (26.7 %) presented with myocardial infarction. Mean estimated glomerular filtration rate was 68.3 ± 30.6 ml/min/1.73m2. More than half of the cases (n = 16, 53.3 %) were done by operators with less than 1-year experience. For angiographic findings, mean SYNTAX score was 22.5 ± 7.4. Half of the patients had an intermediate SYNTAX score, 13 patients (43.3 %) had a low SYNTAX score and 2 patients (6.7 %) had a high SYNTAX score. Mean contrast usage was 232.7 ± 124.8 ml. Almost all cases (n = 29, 96.7 %) were done under intra-coronary imaging guidance (26 cases under intravascular ultrasound and 3 cases under optical coherence tomography). 8 patients (26.7 %) required atherectomy during PCI (7 rotational atherectomy and 1 orbital atherectomy system). Majority of them (n = 24, 80.0 %) underwent provisional stenting, 4 patients (13.3 %) underwent planned 2 stents technique (3 DK crush and 1 Culotte) and 2 patients (6.7 %) had bailout 2 stents technique (1 reverse crush and 1 T-stenting). The overall 30-day MACE rate was 3.3 % in which 1 patient had CV death at 30 days. There was no significant difference between SYNTAX score > 22 and ≤ 22 for 30-day MACE rate (5.9 % vs. 0 %, p = 0.374). Also, there was no significant difference in 30-day MACE rate for gender, LVEF categories, CV risk factors and bifurcation PCI technique.
30-day MACE rate of 3.3 % in our study corresponds to early clinical outcomes of current related major clinical trials. The absence of a significant difference in 30-day MACE rate for SYNTAX score suggests that PCI is an option for complex LMCA lesions when patients refuse CABG or ill patients are not stable to be transferred for CABG in a centre without on-site cardiothoracic service.