Bifurcation/Left Main Diseases and Intervention
When the Culprit is the Left Main: In-hospital and 12-month Outcomes of Left Main Percutaneous Coronary Intervention - A Single-centre Experience
Mohammed Ali Osheiba1, Alexander Zaphiriou2, Sudhakar George2, Adnan Nadir2, Peter Ludman2, Sagar Doshi2, John Townend2, Sohail Khan3
Queen Elizabeth Hospital Birmingham, United Kingdom1, University Hospitals Birmingham, United Kingdom2, Queen Elizabeth Hospital, Great Britain (UK)3
Left main percutaneous coronary intervention (LM-PCI) is one of the most important PCI in terms of prognosis and risk of adverse outcomes despite all recent advances. We investigated patients' characteristics, clinical presentations, procedural details, and key factors associated with adverse outcomes both in-hospital and at 12-month follow-up for LM-PCI.
We retrospectively evaluated 248 LM-PCIs for 239 patients performed at our Tertiary Centre Hospital from January 1st, 2015 to December 31st, 2019. We included patients who had pre-procedure cardiogenic shock (CS). Patients were categorized into stable ischemic heart disease (SIHD) and acute coronary syndrome (ACS) groups. In-hospital major adverse cardiovascular and cerebrovascular events (MACCE) were recorded. A 12-month follow-up for MACCE, hospitalization for heart failure (HF), and target vessel revascularization (TVR) was obtained from routine follow-up visits. Variables with p<0.1 at univariate analysis were included in multivariate logistic regression for the predictors of in-hospital mortality.
A total of 248 LM-PCIs were enrolled [71.84 ± 11.55 years, 179 (72.2%) males]. 166 (67 %) of LM-PCIs were for patients presenting with ACS [71.49 ± 11.89 years, 120 (72.3%) males] including 39 (23.5 %) who presented with ST-segment elevation myocardial infarction (STEMI), 22 (13.3%) with cardiogenic shock (CS) and 16 (9.6%) had out of hospital arrest. The mean hospital stay was 1.52 ± 1.48 days for the SIHD patients and 6.89 ± 12.45 days for the ACS patients. The in-hospital mortality for the ACS group was 25 (15%) with a single case of stroke. In the SIHD group there were three cases of non-fatal MI. The predictors of in-hospital mortality in logistic regression analysis for the ACS group were pre-procedural CS (odd ratios [OR]: 7.86; 95% confidence interval [CI]: 2.37 to 26.02; p < 0.001), not using intracoronary imaging (OR: 3.68; [95% CI: 1.23 to 11.05]; p < 0.02), and use of femoral access (OR: 3.27; [95% CI: 1.09 to 9.88]; p < 0.035). The observed mortality at 12-month for ACS and SIHD patients respectively was 11 (8.3%) and 7 (8.5%), and for non-fatal MI was 6 (4.5%) and 1 (1.2%). There was one stroke in the ACS group. Three patients had TVR in the ACS group and two patients in the SIHD group. Hospitalization due to HF was reported only in three ACS patients.
LM-PCI for ACS carries a higher risk for adverse in-hospital outcomes driven predominantly by CS, not using intracoronary imaging and use of femoral access. At 12-month follow-up, no significant difference was noted between LM-PCI for ACS or SIHD regarding MACCE, TVR, or hospitalization for HF.